Chaplain Application Form
In order to exercise the Charity’s duty to care for its clients and in particular young people, in terms of the Children Act (1989) and the Rehabilitation of Offenders Act (1974) we ask all prospective helpers in young people’s and vulnerable adults’ work to complete this form. The information will be kept confidentially by the Charity, unless requested by an appropriate authority.
NameAddress
Town/City / Post Code
Tel Day / Eve
Service / Contact there?
E mail
Where did you hear about Alabaré?
Are you prepared to undertake relevant training / Yes / No
References Please name two referees whom we may contact. These should be a current or ex-employer(s), representatives of a volunteer body/organisation you have been part of, a professional, someone in a managerial capacity who has known you for at least two years or someone who can give you a character reference. For students, references should be from the head, principal or tutor. **Email addresses are very helpful!
Please exclude relatives
Reference 1 / Reference 2 / Church Leader
Name
Address
Post Code
Telephone
**E mail
How is this person known to you?
Your skills and past experience Please give information about your career, personal interests, hobbies and any voluntary work you are currently doing or have previously done.
Signed:…………………………………………… Date:………………………………….
DECLARATION:
I understand that in undertaking Volunteer work with Alabaré Christian Care Centres I will have access to confidential information regarding clients of the charity. I agree to comply with the charity’s policies and further understand that I will not disclose confidential information to any outside individual or agency without authority from my line manager.
I confirm that the information I have given on this form is correct and complete and that misleading statements may be sufficient grounds for cancelling any agreements made.
Signed:…………………………………………… Date:…………
To All Volunteers:
VOLUNTEERS – CODE OF PRACTICE
Aims and Purpose
This procedure is in place for the help and guidance of all our volunteers without whom, we would not be able to operate.
Our Code of Practice
1. You are a volunteer member of the team and therefore have the right to your views and opinions and to be listened to. Constructive suggestions should be noted and handed to a manager.
2. As a volunteer member of the team you should have strict regard to the confidentiality of the organisation whether on the premises or outside. If you are given confidential information likely to affect the wellbeing of the organisation you should state to that person that you are under an obligation to report it to a manager.
3. You should not accept any gift or favour which may be considered as an influence for the client to receive preferential treatment.
4. You should be aware of the Charity’s policy not to discriminate on race, sex, sexuality, age, class, disability or history of illness.
5. Our policy is to be open to peoples’ values, customs and spiritual beliefs.
6. You must always obey the law in carrying out Charity activities.
7. Advise a manager of any relationship, which is unhealthy, unprofessional or likely to put others at risk.
8. The Charity has a Health and Safety Policy and you should ensure that you comply with it when carrying out any Charity activity.
9. As part of a professional organisation you are representing us and should therefore always portray an appropriate image.
10. You should not at any time divulge details of your personal address or telephone number to clients.
11. Do not under any circumstances lend to, give to, or borrow money from clients.
How can we help to support you?
· If you would like to receive help or training, in any aspect of your position please contact a manager.
· You should never be out of pocket on our behalf. Please see a manager who will complete an expenses claim for any expense, including travel incurred whilst volunteering, made on behalf of the Charity.
· Should you decide to leave us we will happily provide a reference.
· Volunteers are encouraged to attend staff meetings and from time to time specific volunteers’ meetings will also be held.
· A job description relating specifically to your position is available.
As a Volunteer, how do I fit into the team?
We would not exist without the help of volunteers. Please tell us if we have asked you to do a particular job which you do no like.
Because you are a volunteer member of our team and we do rely upon you please give as much notice as possible if you are going to be away.
Finally, thank you for your support and please let us have your comments and ideas.
Name: ………………………………..
Sign: ………………………………….
Date: ………………………………….
PLEASE KEEP THIS COPY FOR YOUR OWN RECORDS
To All Volunteers:
VOLUNTEERS – CODE OF PRACTICE
Aims and Purpose
This procedure is in place for the help and guidance of all our volunteers without whom, we would not be able to operate.
Our Code of Practice
1. You are a volunteer member of the team and therefore have the right to your views and opinions and to be listened to. Constructive suggestions should be noted and handed to a manager.
2. As a volunteer member of the team you should have strict regard to the confidentiality of the organisation whether on the premises or outside. If you are given confidential information likely to affect the wellbeing of the organisation you should state to that person that you are under an obligation to report it to a manager.
3. You should not accept any gift or favour which may be considered as an influence for the client to receive preferential treatment.
4. You should be aware of the Charity’s policy not to discriminate on race, sex, sexuality, age, class, disability or history of illness.
5. Our policy is to be open to peoples’ values, customs and spiritual beliefs.
6. You must always obey the law in carrying out Charity activities.
7. Advise a manager of any relationship, which is unhealthy, unprofessional or likely to put others at risk.
8. The Charity has a Health and Safety Policy and you should ensure that you comply with it when carrying out any Charity activity.
9. As part of a professional organisation you are representing us and should therefore always portray an appropriate image.
10. You should not at any time divulge details of your personal address or telephone number to clients.
11. Do not under any circumstances lend to, give to, or borrow money from clients.
How can we help to support you?
· If you would like to receive help or training, in any aspect of your position please contact a manager.
· You should never be out of pocket on our behalf. Please see a manager who will complete an expenses claim for any expense, including travel incurred whilst volunteering, made on behalf of the Charity.
· Should you decide to leave us we will happily provide a reference.
· Volunteers are encouraged to attend staff meetings and from time to time specific volunteers’ meetings will also be held.
· A job description relating specifically to your position is available.
As a Volunteer, how do I fit into the team?
We would not exist without the help of volunteers. Please tell us if we have asked you to do a particular job which you do no like.
Because you are a volunteer member of our team and we do rely upon you please give as much notice as possible if you are going to be away.
Finally, thank you for your support and please let us have your comments and ideas.
Name: ………………………………..
Sign: ………………………………….
Date: ………………………………….
Alabaré Christian Care and Support
DECLARATION OF CONFIDENTIALITY
I, ………………………………………………………….. hereby declare that I will hold in strict confidence any personal and sensitive information concerning service users, staff and Alabaré, that may become known to me during the course of my duties as a volunteer.
I will not divulge any such information or discuss it with colleagues in any public place.
I also understand that any disclosure of confidential information by me will result in the termination of my duties as a volunteer.
I have a duty to understand my obligations under the Data Protection Act 1998 and Computer Misuse Act 1990, to ensure confidentiality of data held manually, on computer, microfiche and CCTV.
I agree to attend mandatory training sessions and to abide by all Alabaré policies and procedures, copies of which can be obtained from the HR Department.
Signed ………………………………………………
Date ……………………………………………………
DECLARATION
REHABILITATION OF OFFENDERS ACT 1974 (EXCEPTIONS) ORDER 1975 AND (EXCEPTIONS)
(AMENDMENT) ORDER 1986.
Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 and (Exceptions) (Amendment) Order 1986. Applicants are, therefore, required to disclose information about convictions which for other purposes are “spent” under the provisions of the act, and in the event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action by the Company.
Therefore please answer the following questions.
If you answer YES to any of the questions, please give details which may, if you wish, be enclosed in a separate envelope.
Any information given will be regarded as strictly confidential and will be seen only by the designated person. It will be regarded as relevant only to this application and will not necessarily debar you from consideration. The object of this clause is not, in any way, to reflect upon your integrity but it is necessary simply to protect the young and vulnerable people that you may come into contact with.
i) Have you ever been cautioned for a criminal offence, or placed on probation or discharged absolutely or conditionally for a criminal offence? Yes/No
ii) Under the Disqualification for Caring for Children Regulations 1991, have you ever had a child removed from your care or placed under supervision by the local authority?
Yes/No
Signed…………………………………………………… Date…………
CONFIDENTIAL
Volunteer Health and Safety
Declaration
Personal Details
1. Do you have a physical or mental disability or special needs requiring
adjustments in the workplace? Yes / No
2. Are you currently receiving medical treatment or medication? Yes / No
3. Have you consulted a medical professional in the last year for any health
problems? Yes / No
4. Are you having any / awaiting any investigations of any kind at the moment? Yes / No
I declare that all the information supplied is true to the best of my knowledge and any false or misleading information may result in termination of my volunteer placement.
I understand that I may be required to provide further information.
Under the Data Protection Act 1998 you are advised that information given on this health declaration form will be held on computer and/ or manual records and at all times will remain confidential.
Signed: ………………………………………………………… Date: ………………………
Emergency Contact Information
Next Of Kin
My Name is:
Alabaré Christian Care and Support
Riverside House, 2 Watt Road, Salisbury SP2 7UD
Telephone 01722 322882
Alabaré Christian Care and Support aims to allow everyone equal access to our available jobs. We are committed to policies that will not discriminate on the grounds of any of the nine protected characteristics covered by the Equality Act 2010 (unless it is a proven requirement for the job).
We are therefore required to record certain details of our applicants in order to ensure non-discriminatory behaviour. This information will be used for statistical purposes only and will not be made available to your interviewers.
Name ______
Job applied for & Ref No. ______
Date of birth: ______
Are you? oMale oFemale oOther oWould prefer not to say
Do you consider you have a disability? o Yes o No oWould prefer not to say
Are you married or in a civil partnership? o Yes o No oWould prefer not to say
What is your sexual orientation? o Bisexual o Gay o Heterosexual o Lesbian
oWould prefer not to say
Religion or Belief ______o None o Would prefer not to say
What is your Nationality?
o British o Any other (specify if you wish)______
How would you best describe you ethnic origin?
ASIANo Bangladeshi o Chinese o Indian o Pakistani
o Any other Asian background (specify if you wish) ______
BLACK
o African o Caribbean
o Any other Black background (specify if you wish) ______
MIXED ETHNIC BACKGROUND
o Asian and White o Black African and White o Black Caribbean and White
o Any other Mixed ethnic background (specify if you wish)______
WHITE
o Any White background (specify if you wish) ______
Where did you learn about this Vacancy?______
Thank you for completing this form.
Alabaré Christian Care Centres is a company limited by guarantee, trading as Alabaré Christian Care & Support.