CONFIDENTIAL

VOLUNTEER APPLICATION FORM

Thank you for offering your help as a volunteer. You will be involved in work that supports people with mental health needs. Just as we need to know about the special needs of those we care for; it is important too that we know a little about each person who is helping them.

It would be helpful, therefore, if you could complete the following details and return the form to us at the address shown above. The information will be treated as confidential.

PERSONAL DETAILS

Title
(Mr, Mrs, Ms etc) / First Name(s) / Surname
(block letters please)
Home address
Postcode
Telephone / Mobile No
Email
Do you have a current driving licence? / YES / NO
Where did you hear about this vacancy?

CHARACTER REFERENCES

Please supply the names and address of two referees (not relatives) who can supply a character reference. You are advised to seek permission from your referees prior to us contacting them.

Name:

/ /

Name:

/

Position:

/ / Position:

Organisation:

/ / Organisation:

Address:

/ / Address:
Telephone No / (Please include STD code) / Telephone No / (Please include STD code)
Are you related to an employee of Herefordshire Mind? If YES Please give details below. / YES /NO
In selecting suitable individuals to be volunteers for Herefordshire Mind, it is necessary that we be aware of any criminal convictions. This information will be treated confidentially, and may not necessarily result in you being refused as a volunteer.
Have you ever been convicted by any Court of Law for any offence?
(other than road traffic offences) / YES / NO
If YES please give details of convictions, including date(s).
Have you ever worked on a voluntary basis? If so, in what capacity? / YES / NO
Have you any previous paid work experience? If so, what? / YES / NO
What skills / qualifications do you have?
Have you had any experience of mental illness?
How did you hear of Herefordshire Mind?
What are your reasons for volunteering with Herefordshire Mind?
Which department/activities are you interested in being involved with?
(see list on separate sheet)

OUTSIDE ACTIVITIES AND INTERESTS

Please tell us about your main interests and hobbies outside work.
What official positions have you held (if any)?

Disabled Applicants

We guarantee to interview disabled applicants who meet the essential requirements of the post. Please confirm therefore whether you have a disability.

Do you have any special requirements to enable you to attend for interview, or to assist you in the interview process?

Declaration

I declare that the details in this application form are to the best of my knowledge, true.

Signed Date

W:\Human Resources\Forms - Personnel\Current\Volunteer Application Form Jan07.doc / Updated Jan07