LIFELINE VOLUNTEER/PEER MENTOR

INFORMATION PACK

Thank you for your interest in becoming involved with Lifeline as a possible volunteer/peer mentor

Please find enclosed an application pack, including an application form and further details of the opportunities we offer here at Lifeline. If you are interested in making an application, please complete the form enclosed and return it, to the address below.

When I receive your application form, I will be in contact to arrange an interview. I look forward to hearing from you shortly. If you have any other queries, please do not hesitate to contact me.

Thank you.

Chloe Rees

Lifeline Recovery Service

54A Backstage

Old Music Hall

Marston Lane

Oxford

OX4 1JE

Please complete form in black ink and return to Chloe Rees at the relevant service or visit for more information

Role Applied For:______

Family name/surname:______

Forename(s)/given name(s):______

Address:______

______Postcode:______

Telephone – Home ______Mobile______

Work ______Email______

Paid Work or Volunteer Work Experience (Please give details of your present or last position)

Employer/Organisation:______

Address______

From: (month, year)______To: (month, year)______

Summary of key responsibilities: ______

______

______

YOUR EXPERIENCE, SKILLS AND KNOWLEDGE

Please give brief details of any other relevant work experience, skills, personal qualities and qualifications giving details of your experience, skills and knowledge you could use whilst volunteering for Lifeline.

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Please give brief details of any relevant qualifications you may have or training courses you have attended that may be relevant to working at Lifeline.

Course title / Date completed / Length of course / Level of qualification

YOUR HOBBIES AND INTERESTS

Please give brief details of ANY relevant hobbies and interests.

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PERSONAL STATEMENT

Why would you like to volunteer within drug and alcohol services?

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Volunteering Interests

Please indicate which service you would be interested in volunteering at (Please tick as many as you like).

Old Music Hall
Oxford / Other areas in Oxfordshire – please specify
Banbury Health Clinic
Banbury
Marlborough House
Witney

Availability

Please indicate which period you would be available to volunteer.

From: ______To: ______

Please mark with a tick which times/days of the week you could be available

Monday / Tuesday / Wednesday / Thursday / Friday
9:30 am – 1 pm
1pm – 5:00 pm

Do you have any medical conditions or disabilities that could affect yourrole as a volunteer? (A disability or health problem will not prevent full consideration of your application)

Yes/No

If YES please give details:

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We recognise and welcome our responsibility to remove any barriers for disabled people. We are committed to making reasonable adjustments wherever possible and it would be helpful to know your needs in order for us to do this.

Declaration of Criminal Record

Have you ever been convicted of a criminal offence, cautioned or given a bind over?

Yes/No If yes, please give details:

Date / Offence / Sentence

Rehabilitation of Offenders Act 1974 - Volunteering with Lifeline Services involves contact with vulnerable young people and adults, therefore all spent offences must be disclosed.

REFEREES
References will be taken up once an offer for a volunteer role has been made and verbally accepted. Please give TWO independent referees and indicate in what capacity they are known to you. At least one should be from EITHER a professional (previous job or voluntary work) OR from education i.e. school, college etc. Please do not use referees who are related to you.
Name:
Organisation:
Address:
Telephone no:
Relationship: / Name:
Organisation:
Address:
Telephone no:
Relationship:

In accordance with the Data Protection Act 1998 I give my consent for the information contained in this form to be processed in accordance with Lifelines volunteer policy for the purposes of recruitment. I understand that if offered the volunteer placement, this application form will be held by Personnel for the duration of my volunteer placement and destroyed in line with the Lifeline Data Protection Policy.

The information given is correct to the best of my knowledge. I understand that because of the sensitive nature of volunteer duties a CRB (Criminal Records Bureau) check will be required.

Signature:______

Date:______

Criminal Records Bureau Checks(CRB)

As a volunteer, you may be dealing with vulnerable adults,young people or children and so it is essenstial that the correct checks are carried out, to protect our volunteers and those that they will be working with.

Enhanced CRB (Criminal Records Bureau) checks will be carried out after the relevant form has been completed and a member of staff has seen two acceptable forms of identification.

Identification should consist of at least one item of photographic identification:

  • Passport
  • driving licence
  • failing that, a birth certificate

also,

  • P45 or p60 with National Insurance Number
  • Evidence of a change of name, eg marriage certificate
  • Plus at least two items of address related evidence from different sources, eg utility bill, mortgage statement; containing your full name and address.

Checks like these are important so that we can ensure the safety of all the people we work with. We work within confidentiality policies, your information will be treated as confidential. A criminal record will not necesarliy exclude you from volunteering, we take these issues into account on an individual basis.

A Registered Charity No: 515691 and A Company Registered by Guarantee No: 1842240

Registered Office: 101-103 Oldham Street, Manchester M4 1LW

MONITORING FORM

Dear Applicant,

Lifeline is determined to be an Equal Opportunities organisation. This means that we believe that everyone in society is entitled to a fair deal, and that we will make every effort not to discriminate against you. So that we can see how effective our policies are, and make changes if they are not effective, we need to monitor all applicants seeking employment with us. We are therefore asking for your co-operation in completing this monitoring form. Without your co-operation it will be difficult to establish whether our commitment to Equal Opportunities is working. The information requested is confidential and anonymous and will be used purely for monitoring purposes. It will not be used as part of the selection or recruitment procedure.

The form will be separated on receipt of your application. The recruitment panel will not see this form.

Do not put your name on this form. If you do not wish to answer any of the questions, please leave the space blank.

Post applied for: ______
Gender: Male Female Age: ______years
Caring Responsibilities
In the past people, (particularly women), who are responsible for the care of children, elderly relatives or others, have been discriminated against in job applications. Do you have major responsibility for the care of any dependents? YES NO
Sexuality
Are you a gay man, a lesbian or bisexual ? YES NO
Disability
A disability or health problem does not preclude full consideration for a job at Lifeline, unless stated in the job description. Applications from people with disabilities are welcome.
Do you have a disability? YES NO
Ethnic Origin
The object of ethnic monitoring is to ensure that racial discrimination does not take place. Ethnic origin refers to members of an ethnic group who share the same cultural identity. This does not mean country of birth or nationality.
I would describe my ethnic origin as:
Bangladeshi / Irish / East African / Asian / White British
Indian / Pakistani / Chinese / Vietnamese / Black British
Caribbean / Somali / Other African / Middle East
Other black / If other Black please specify
Other White / If other White please specify
Other Information
Please feel free to provide any additional information you wish. You may, for example, want to provide information about previous discrimination
Advertising
Lifeline wishes to make sure that all jobs are advertised as widely as possible. Could you please say how you heard about this post?

Thank you very much for your co-operation in completing this form.

A Registered Charity No: 515691 and A Company Registered by Guarantee No: 1842240

Registered Office: 101-103 Oldham Street, Manchester M4 1LW