Current Roles Are Advertised on the Website At

Volunteer Application Form

Thank you for your interest in volunteering with St Mungo’s Broadway. If you need assistance with completing this form, please telephone 02035408558 or email us at

Your contact details (please complete this section in BLOCK CAPITALS)
Title / Mr / Mrs / Miss / Ms
First Name
Surname
Address
Postcode
Telephone / Daytime: / Mobile:
Email

Current roles are advertised on the website at:

Please Specify Which Volunteer Role you are Interested in:

Location of Volunteering (City/Town/London Borough):

Volunteering Availability
Monday / Tuesday / Wednesday / Thursday / Friday / Saturday / Sunday
AM
PM
Eve

N.B. All projects have varying needs for volunteers: please check the website for details

How did you find out about volunteering at St Mungo’s Broadway?
Friend/Family recommended / Adult Education/College / Timebank
St Mungo’s Website / University / Charity Job
Library / Do It Volunteer website / Local Council Magazine
Volunteer Centre / Donor/Contributor / Promotional event
Took part in one-off event / Mungo’s Bulletin/Newsletter / i-volunteer
Project or service at St Mungo’s - tell us which one:
Other – please tell us where:
DBS Checks

For some roles we may ask volunteers to do a DBS check (previously called CRB checks). Having a criminal record will not necessarily prevent you from volunteering with St Mungo’s Broadway, but some convictions may require further discussion.

I have criminal convictions, spent or unspent I have no criminal convictions, spent or unspent

About you
Why you would like to volunteer at St Mungo’s Broadway?
Why are you interested in the specific role you are applying for?
Additional relevant information (e.g. languages spoken/previous experience)
Are you currently a resident of St Mungo’s Broadway? Yes No
Are you connected to any clients at St Mungo’s Broadway? If yes, please tell us how:
Do you have a full driving licence? Yes No
Reference Details

Please provide us with the details of two people we may contact as referees, to comment on your suitability for volunteering. These can be colleagues, tutors or people of a professional standing in the community but not friends or family members.

Referee One

Referee Two

Name:

Address:

Email:

Telephone:

How do you know this person?

To keep you informed on other ways of supporting St Mungo’s Broadway, and how you could make a difference, we would like to contact you by post in the future. Please place an x in the box if you do not wish to be contacted [ ]

Please place an x in the box if you’re happy for us to contact you byemail [ ]

Next of Kin Contact

Please provide details of a named person to contact in case of any situation whilst undertaking your volunteer work

Name of contact
How do you know this person?
Contact telephone number:

We take great care of all your personal information, and because we comply fully with Data Protection guidelines, will ensure it is confidentially stored. It will not be passed on to a third party, but we do use statistics to monitor our progress on equality and diversity.

Signature / Date

Return your form:

By post to: St Mungo’s Broadway, Volunteer Services, Brook House, 4th Floor South Wing, 229-243 Shepherds Bush Road, Hammersmith, London W6 7AN

By email to:

Equal Opportunities Monitoring Form

A full copy of our ‘Equal Opportunity Policy Statement’ is available on our website, or can be obtained from the HR Recruitment Department on 020 8762 5500.

Name:
Volunteer role applied for:
Employment Status:
Full Time Part Time Student Full Time Student Part Time Unemployed
Self Employed Prefer not to say
Gender
Male / Female / Transgender
Prefer not to say
Date of Birth:
Nationality:
Ethnic Origin
White
British / Irish / Scottish
English / European / Other
Mixed
White and Black Caribbean / White and Black African / White and Asian
Any other mixed background
Asian or Asian British
Bangladeshi / Indian / Pakistani
Middle Eastern / Other Asian Background
Black or Black British
African / Caribbean / Other
Chinese or Other Ethnicity
Chinese / Any other ethnic group
Other
Prefer not to say
Religion
Baha’i / Buddhism / Christianity
Catholic / Hinduism / Druidry
Heathenism / Islam / Jainism
Judaism / Paganism / Rastafarianism
Scientology / Sikhism / Wicca
Zoroastrianism / Of no religion / Other
Prefer not to say
Sexual Orientation
Bisexual / Gay / Heterosexual
Lesbian / Other / Prefer not to say
Ex Service User
Definition: Ex-Service User
Individuals who in the last five years have been a resident/used St Mungo's or similar agencies' operational services.
Have you been / or are you a service user?
Yes / No / Prefer not to say
Disability
St Mungo’s Broadway is Disability Symbol accredited.
Would you describe yourself as someone who has a physical or mental impairment which has a substantial and long-term adverse effect upon his or her ability to carry out normal day-to day activities?
Yes / No / Prefer not to say
If yes please indicate below which would best describe your impairment:
Physical Impairment e.g. Mobility, Dexterity
Sensory Impairment e.g. Visual, Auditory, Speech
Mental Health Condition e.g. Depression, Schizophrenia
Learning / Cognitive Impairment e.g. Dyslexia
Long-Standing Illness / Condition e.g. Cancer, HIV
Other (please specify):