Task Force Volunteer Application Form

TASK FORCE VOLUNTEER APPLICATION FORM

Thank you for your interest in volunteering for Diabetes UK North West Region. Please complete all the fields and return this form to Volunteering, Diabetes UK, The Boultings, 1st Floor, Winwick Street, Warrington, WA2 7TT or by email to:

Your Details

Title (Mr/Mrs/Miss etc)
Forename
Surname
Address
Postcode
Telephone
Mobile phone
Email
I am aged over 18

Emergency Contact Details

Who should we contact in an emergency?

Name
Address
Telephone
Mobile phone
Relationship to you

REFERENCES

If you have worked in the past five years, at least one reference should be obtained from your last employer. If not, give the names of people who know you well.

Referee one

Name Capacity known to you

Address

Telephone Email

Referee two

Name Capacity known to you

Address

Telephone Email

REHABILITATION OF OFFENDERS ACT 1974

Do you have any unspent convictions? / Yes / No

If yes, please specify:

If you would like to talk with someone about this before applying, please contact the Safeguarding team at or telephone 0207 424 2501. Please note that a conviction will not necessarily exclude you from volunteering with Diabetes UK, but will be taken into account when assessing your suitability. Some volunteer roles will require you to complete a Data Barring Service check, DBS (England and Wales) / PVG (Scotland) / ANI (Northern Ireland).

About You

Please give details of any special requirements that might affect your volunteering so that we can make any necessary adjustments (e.g. diet, disabilities, religion)
Please tell us why you would like to volunteer for Diabetes UK and identify any specific skills or experience that you feel may be useful. Have you done any volunteering before?

Data Protection

Diabetes UK takes data protection very seriously. We promise we will not pass your details on to other organisations. If you do not wish to receive further mailings from Diabetes UK about our work and that of our trading company, please tick the box.

Personal Declaration

I hereby apply to become a volunteer with Diabetes UK. I also agree to abide by all Diabetes UK policies and guidelines and understand that I have a responsibility for my own and other’s Health & Safety while volunteering with the charity. If accepted, I will abide by the principles of volunteering outlined in the charity’s Volunteering Policy. I agree that Diabetes UK may hold and use the data on this form for the purposes of administering and supervising my work with the charity and that such data may be available to those who reasonably need to know the same within the charity.

Sign or print name:

Date:

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