The information you give will be treated as confidential. If you have any questions please do call, or email using the contact details above.

Title and Name
Address (including post code)
How long have you lived at this address?
Telephone No
Mobile No
Email Address
Date of Birth
Where did you hear about us?
Reason for wanting to become an advocate
Skills/experience you think would be useful in your role as an advocate
Are there any subjects/skills you would like to learn about/develop?
Would you be interested in becoming a volunteer for our Appointment Buddy service (assisting Barton residents with accessing Primary Health care)?

We need two written references to support your application. Please give details of two people who can be contacted for this purpose. If possible one of your referees you will have had a professional relationship with.

Name / Name
Address / Address
Tel. no. / Tel. no.
Relationship to you / Relationship to you
How long have you known them? / How long have you known them?
Email / Email

Do you have a clean driving license?

Do you have access to a car?

Getting Heard has a duty to protect advocates and partners that are involved with the organisation. In working towards this all volunteer advocates undergo an enhanced Disclosure Barring Service (DBS) check. However, a criminal conviction does not necessarily mean that you cannot be a volunteer with Getting Heard.

Have you ever been convicted of a criminal offence by a Court of Law or do you have a criminal case pending?

YESNO

If the answer is yes, please give brief details below (including any spent offences - as these may still show up on your DBS check).

Is there anything else relevant to the DBS check you feel Getting Heard should know?

All information given on this form is form is true and accurate to the best of my knowledge.

I do /do not* agree to my details being held on the Getting Heard database.

(* Delete as appropriate)

Signature:------

Date:------

DATA PROTECTION ACT 1998

All records held by Getting Heard comply with the Data Protection Act 1998

Equal Opportunities Monitoring Form
/
Confidential
This information will be treated as confidential, and used solely for monitoring purposes. The form will be separated from the application form. The form will not be considered as part of the selection process.

If you prefer not to disclose any of this information, please leave the section(s) blank

I would describe my ethnic origin as (please tick one box only)
Please tick this box if you would prefer not to answer this question:
White / Asian or Asian British
British / Indian
Irish / Pakistani
Any other white background / Bangladeshi
(please describe) / Any other Asian background
Mixed / (please describe)
White & Black Caribbean / Black or Black British
White & Black African / Caribbean
White & Asian / African
Any other mixed background / Any other Black background
(please describe) / (please describe)
Chinese or other ethnic group
Chinese
Any other background (please describe)
Please describe your religious group
Please tick this box if you would prefer not to answer this question:
How would you describe your sexual orientation?
Please tick this box if you would prefer not to answer this question:
Heterosexual / Lesbian
Gay / Bisexual
Other (please describe)
Please indicate your age
Age / Date of Birth
Disability
Do you have a disability as defined by the Disability Discrimination Act 1995?
YesNo
If ‘yes’, please give brief details of the effects of your disability on your day-to-day activities, and any other information that you feel would help us to accommodate your needs and thus meet our obligations under the Disability Discrimination Act 1995. A disability in no way precludes you from consideration for a position and Getting Heard wishes to assist and support applicants with a disability through the recruitment process. Please use an additional sheet as required…