Grow, Eat and Learn application
For office use only:
Date form received: Date prospective volunteer contacted:
Informal meeting agreed Y/N* Date: Time:Confirmation sent? Y/N* (date)
Refs sent: Date: CRB (If applicable): Date:
Due to the high demand for places on the course, we may not have space available. In this case we will do our best to signpost you to other courses and volunteer projects.
Name:………………………………………………………………………………
Address:………………………………………………………………………………
………………………………………………………Post code………………..…
Email: ………………………………………………Telephone No:.……………
Area of volunteering you are interested in getting involved in-
Which days are you available to work (hours and days to be negotiated unless stated otherwise)-
How did you hear about the farm and what prompted you to apply? (Please circle) Farm Website, local knowledge, Volunteer Bristol, word of mouth, support worker, any other (please specify)
What inspired you to want to volunteer at Windmill Hill City Farm?
What do you hope to gain from volunteering with us?
Have you volunteered with us previously or volunteered with other organisations?
Are you able to work without on-going supervision after receiving initial instruction?
YES NO
Do you consider yourself to have a mental health issue? YesNo
Do you consider yourself to have a learning difficulty?Yes No
If yes, do you have a care plan? Yes No
.
Do you have a current or recent drug or alcohol issue?
Yes No
Are you receiving a funded package of care from Bristol City Council?
Yes No
If ‘Yes’, which organisation supports you?
NB :During your initial interview, it would be helpful if you could talk to us about how your support needs may affect your volunteer activities at the farm and how we can support you.
If other organisations or people give you support eg. Supported housing, C.P.N, social worker? Please put their details below in the reference section
Please give details of two people who could provide a reference (this can be from people who know you professionally or personally).
Name ...... Name ......
Address ……………………………………….Address ...... ….
......
...... …......
………………………………………………………………………………………………………………
Phone no...... Phone no...... …
Email Address……………………………….. Email Address……………………………….
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Declaration
If we consider you to be a supported volunteer, information may be requested by social services, such as your name and the number of hours you work. This is a requirement for our funding. Whilst respecting people’s confidentiality, if Windmill Hill City Farm workers feel sufficiently concerned for the health and safety of individuals using the group, they may contact relevant agencies on your behalf. We always aim to do this with your consent but there may be circumstances in which this is not possible. We will also request the supporting organisation named in your references to complete a risk assessment on your behalf.
Please sign and date this application if you agree to the terms written above:
Signature ...... Date ......
Volunteer Details Form
Date of birth: ....………../……………/………….
Details of Doctor:
Name ......
Surgery ...... ……………. Telephone No: ………………………
Please detail medication you are taking
...... ……
...... …….
...... ……
...... …….
...... ……
Details of medical history, e.g. Diabetes, asthma, heart trouble, allergies
...... ……
...... …….
...... ……
...... …….
...... ……
...... …….
Details of someone we can contact in case of an emergency:
Name: ...... ……… Telephone: ……………………….
Relationship to you ...... ……
If I am working on the Farm, gardens or maintenance I will ensure I have an up to date Tetanus booster
I declare that the above information is correct.
Signed: ……………………………………………………………………………………………..
Date: ……………………………………
Rehabilitation of Offenders Act 1974
We are required to take certain safeguards to protect vulnerable groups who use Windmill Hill City Farm, and therefore must ask you for details of any criminal convictions.
Due to the nature of the project, the provisions of Section 4(2) of the Rehabilitation of Offenders Act do not apply. Information about convictions, which for other purposes are spent, must therefore be disclosed.
Any information given will be treated in strict confidence and used only in connection with this application. It will not necessarily prevent you from working at the Farm. Dismissal may result if it is discovered that previous convictions were not disclosed.
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DECLARATION FORM
Surname and First Names:…………...... …………...
Current Address: ......
......
...... Post Code: ......
1.Have you been convicted or cautioned of any criminal offence, whether "spent" or not?
Answer YES or NO ......
2.IF YES, give the following information in respect of each conviction (please continue overleaf if necessary)
Date of
Nature of offence conviction/caution Details of sentence
I declare that the statements made and information given in this document are true to the best of my knowledge and belief.
I agree that such enquiries as may be considered necessary may be made to the police or any other person or organisation.
I understand that the police will disclose any cautions or convictions for the purposes of this application only.
Signed: ...... …….....Date:………......
Thank you for your application; please return this form to
Nicky Bacon, Windmill Hill City Farm, Philip Street, Bedminster, Bristol BS3 4EA.
Equal Opportunities Monitoring Form
Windmill Hill City Farm is committed to equal opportunities for all, regardless of race, colour, creed, ethnic or national origins, gender, marital status, sexuality, disability or age. Please help us monitor the implementation of our policy by completing the following form. All information is treated with the strictest confidence and will only be used for statistical monitoring. When we receive your form we will detach it from your booking form and file it anonymously.
Gender
Are you: Male Female
Ethnic Origin
Choose ONE section from A to E, then tick the appropriate box to indicate your cultural background. These are the categories developed by the Commission for Racial Equality.
A White
British
Irish
Any other White background, please write below:
B Mixed
White and Black Caribbean
White and Black African
White and Asian
Any other Mixed background, please write below:
C Asian or Asian British
Indian
Pakistani
Bangladeshi
Any other Asian background, please write below:
D Black or Black British
Caribbean
African
Any other Black background, please write below:
E Chinese or other ethnic group
Chinese
Any other, please write below:
Disability
Do you consider yourself to have a disability: YesNo
Are you registered as disabled: YesNo
Age
Are you 16-24 25-49 Over-50 Over 70
ReligionSexual Orientation
□ Christian □ Lesbian Gay Bisexual
□ Muslim □ Heterosexual
□ Hindu□ Prefer not say
□ Sikh
□ JewishTransgender
□ No Religion□ Yes
□ Any other Religion□ No
□ Prefer not to say □ Prefer not to say