For assistance in completing this form please contact us at

or 01225 354650

Please return completed forms to:

Volunteer Coordinator,
Julian House
55 New King St,
Bath
BA1 2BN /

Tel: 01225 354650

e-mail:
APPLICATION FOR VOLUNTEERING (Henrietta Street)
Section one: Personal Information
Title: / Mr / Miss / Ms / Mrs / Other:
Please state
Surname:
(family name) / Forename(s):
(given names)

Permanent address: Contact numbers:

Postcode: / Home:
Work (if convenient):
Mobile:
e-mail:
Please note that you need to be 18 or over to volunteer at Henrietta Street
Do you have any health problems that you feel we should be aware of?
Section two: Employment status
Employed / Non-employed / Retired / Student / Other
Occupation/course:
Name of Employer/University/College:
Section three: Availability
Please give us an indication of the days and times you hope to be available by entering a ü in the appropriate box(es)
Monday / Tuesday / Wednesday / Thursday / Friday / Saturday / Sunday
AM
PM
Evening

REGISTERED OFFICE

Julian House, 55 New King Street, Bath BA1 2BN - A Charity registered under the Industrial and Provident Societies Act 1965 No. 19305R

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Section four: General information
Why do you wish to volunteer at Julian House? What do you hope to gain from the experience?
(continue on a separate sheet if necessary)
Qualifications, Training & Work Experience
Have you done any work (paid or voluntary) or training/qualifications, which may be relevant?
Other skills and Experience
Are there any skills or experience that you would like to develop during your volunteering?
Section five: Equality & Diversity Monitoring Information

Julian House is striving towards Equal Opportunities. Julian House aims to ensure that no applicant, volunteer, employee or client receives less favourable treatment on the grounds of sex, material status, race, colour, nationality, age, sexual orientation, impairment or political belief. Please take the time to complete this form. All returned and completed forms help us to evaluate whether or not volunteering in Julian House is fair and open to all parts of our communities. The form is used for Equality and Diversity monitoring ONLY. Please fill in all details on this form.

How did you hear about voluntary work at Julian House?

Please mark with ‘X’ in the appropriate boxes

Gender Age Sexual Orientation
Female / Under 20 / 20 – 29 / Lesbian / Heterosexual
Male / 30 – 39 / 40 – 49 / Gay / Bi-sexual
50 – 59 / 60 plus / Do not wish to answer / Other
(please state)
Ethnicity
White / Mixed
Asian/Asian British / Black/Black British
Chinese / Do not wish to answer
Other
(please state)
/ Nationality (please state)
Religion
NB: Categories as defined by the Office of Population Census and Surveys (OPCS)
Christian / Jewish / All other religions
(please state)
Muslim / Hindu / No religion
Buddhist / Sikh / Do not wish to answer
Disability
Do you consider yourself to be a disabled person? / Yes / No / If ‘yes’ please indicate your impairment
The Disability Discrimination Act 1995 defines a person as having a disability if he or she has a physical or mental impairment which has a substantial and long term adverse effect on his/her ability to carry out normal day to day activities.
Do you meet this definition? / Yes / No

REGISTERED OFFICE

Julian House, 55 New King Street, Bath BA1 2BN - A Charity registered under the Industrial and Provident Societies Act 1965 No. 19305R

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Section six: References
Please provide us with the details of two people whom we may contact as referees to comment on your suitability for volunteering. These can be colleagues or someone in a position of responsibility who knows you well enough, although not a member of your family.
Name: / Name:
Address: / Address:
Phone no:
E-mail: / Phone no:
E-mail:
What is your relationship to this referee? / What is your relationship to this referee?
How long have you known them? / How long have you known them?
Section seven: Criminal Record
Julian House promotes equality of opportunity and welcomes applications from a diverse range of candidates. Criminal records will be taken into account for recruitment purposes only when the conviction is relevant. Having a conviction will not necessarily bar you from volunteering with Julian House. This will depend on the circumstances and background to your offence(s)
Have you ever been convicted of any criminal offence? Yes/No
If Yes please provide brief details:

I certify that the information in this application is accurate and complete to the best of my knowledge and I acknowledge that giving false information or omitting material facts can lead to being asked to withdraw from volunteering. I understand that Julian House may decline my application without giving a reason. Julian House may contact any educational institution, reference or employer listed on this application, to verify that the information I have given is complete and accurate. I hereby release all involved parties from any liability arising from such investigation.

Signed: / Date:

DATA PROTECTION: The personal information provided on this application form will be used for employment purposes and processed, held and accessed under the terms of the Data Protection Act 1998. No personal information will be passed to a third party without your permission.

Please return completed application form to Volunteer Coordinator at:
Julian House, 55, New King St, Bath, BA1 2BN or email

- END OF APPLICATION FORM -

REGISTERED OFFICE

Julian House, 55 New King Street, Bath BA1 2BN - A Charity registered under the Industrial and Provident Societies Act 1965 No. 19305R

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