Volunteer Application Form

Please forward a copy of this form to:Changing LivesCentral Office, Unit D13, Marquis Court, Tenth Avenue West, Team Valley, Gateshead, NE11 0RU.

Email:

Please state which role/s you are applying for

Personal Details

Name:
Address:
Postcode:
Date of birth
Home phone:
Mobile:
Email:
Emergency contact. Name, relationship to you and contact number:

Relevant experience

Please tell us about any relevant voluntary or paid experience that you have andwhy you wish to volunteer for Changing Lives:

Are you currently a client of Changing Lives?Yes ☐ No ☐

Have you ever been a client of Changing Lives?Yes ☐ No ☐

References

Please provide details of someone who has known you for at least a year (this could be a previous employer or work colleague, teacher, doctor etc.). Please do not use relatives as references.

Referee 1 Referee 2

Address

Postcode: / Postcode:
Phone
Email

What is your relationship to the referees?

Please detail hours/days per week you can offer

Day of the week / Morning (Please specify times) / Afternoon (Please specify times)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Additional information

Please detail any needs that you have and would like us to take into account:

(e.g. Disability, caring responsibilities etc. This information will be treated as strictly confidential)

7. Declaration

Rehabilitation of Offenders Act 1974

All information given will be completely confidential.

Because of the nature of our work, we need to know:

Do you have criminal record*? Yes ☐ No ☐

*NB. This includes 'spent' convictions as defined by the Rehabilitation of Offenders Act 1974. We undertake DBS checks for all volunteers who are likely to come into contact with Changing Lives’ clients.

If the answer is YES, we may wish to discuss it with you. It will not necessarily prevent you from becoming a volunteer. If you wish, you may give further details below:

Would you occasionally like to receive news about volunteering at Changing Lives via email?

Yes ☐ No ☐

Declaration

I declare that the information that is recorded in this form is accurate and true.

I understand that providing misleading or false information may disqualify me from undertaking volunteering activity for Changing Lives.

Signed Date

Volunteer monitoring form – Confidential

We wish to ensure that all aspects of volunteering with Changing Lives reflect equality of opportunity. Your co-operation in completing this form is greatly appreciated. Any information you give will be strictly confidential. You do not have to answer any of the questions, but to achieve a true picture of who volunteers for Changing Lives we would like to achieve 100% response.

Not answering any question(s) will not affect your application in any way.

Name Position applied for

Email address Date

/ /2017

1. Ethnic origin

The classifications we have used are those currently used by the Census. If you wish to classifyyourself in some other way, please use the additional space provided.

White / Mixed / Asian or Asian British / Black or Black British / Chinese or other ethnic group
White British ☐ / White & Asian ☐ / Indian ☐ / Caribbean ☐ / Chinese ☐
White Irish ☐ / White & Indian ☐ / Pakistani ☐ / African ☐ / Any other (please state below) ☐
Any Other White background ☐ / White & Black
African ☐ / Bangladeshi ☐ / Any Other Black
Background ☐
Any Other Mixed background ☐ / Any Other Asian
Background ☐

2. Gender (please tick) Male ☐ Female ☐

3. Date of Birth

4. Disability

A disability is a physical or mental impairment that has a substantial long-term adverse effect on your ability to carry out standard day to day activities.

Do you have any disabilities? ☐ Yes ☐ No (If yes please tick the appropriate box)

☐ Physical impairment ☐ Mental impairment ☐ Other (please specify) ______

If you answered yes to the above question, please contact the HR department to ensure that all arrangements made are to your satisfaction.

5. Sexual Orientation

I would describe myself as (please tick) Heterosexual ☐ Lesbian ☐ Gay ☐ Bisexual ☐

6. Religion or belief

Christian ☐ Hindu ☐ Muslim ☐ No Religion ☐

Sikh ☐ Jewish ☐ Buddhist ☐ Other (please state)

How did you find out about volunteering for Changing Lives? i.e. social media, jobcentre, website