Application Form for Home VisitingVolunteers

Home-Start Colchester

Home-Start Colchester is committed to safe recruitment practice as an important part of safeguarding and protecting children and vulnerable adults

Thank you for your interest in Volunteering for Home-Start Colchester. It is really helpful if you can give us as much information as possible about your experiences, interests and availability as a volunteer. If you have any questions about this form, please do not hesitate to contact us. Contact details are at the end of this form.

Confidential

If you have difficulty completing this form, please ask the Home-Start organiser/co-ordinator for assistance.

Name
Address including postcode
If at the above address less than five years, please give previous address
Tel.No. (Home) / Tel.No.(Mob)
Date of Birth / Place of Birth
Email address
Emergency Contact Name & Number
How did you hear about Home-Start Colchester
Word of mouth☐ School, college, university☐
Event☐ Internet☐
Media (radio, TV, newspaper)☐ Leaflet or poster☐
Volunteer Centre ☐ Other☐, please give details below:
REFERENCES: Please provide details of two people who have known you for at least two years that we can ask for references regarding to your work/studies/experiences to volunteer with Home-Start Colchester (not a relative). At least one of these must be current/past employers, places you have volunteered or a teacher/tutor/social worker or other professional such as a religious leader who may be contacted by Home-Start Colchester.
If you are unable to provide any of these references please contact the Home-Start Office for advice prior to submitting your application.
Are you happy for Home-Start to contact the reference in advance of your training?
Please ask permission prior to submitting referees details and confirm full address.
1. Title: Mr/Mrs/Ms/Miss
Name:
Address:
Post Code:
Tel No.
Email Address / 2. Title: Mr/Mrs/Ms/Miss
Name:
Address:
Post Code:
Tel No.
Email Address
Occupation:
How do you know this person?
When did you last have contact with this person? / Occupation:
How do you know this person?
When did you last have contact with this person?

We would like to get a picture of your experience to date, in the first box please give us details of any paid employment, in the second box details of any voluntary or unpaid work and in the third box details of gaps in employment with reasons e.g. career break to look after children or other dependents, travelling, training or education.

Please tell us about any paid employment, starting with most recent

Employer / Job title / From / To / Brief description of duties / Reason for leaving

Please tell us about any voluntary or unpaid work, starting with most recent

Employer / Job title / From / To / Brief description of duties / Reason for leaving

Please tell us about gaps in your employment history, starting with the most recent

From / To / Reason
Please give information about any skills, qualifications, training courses here starting with most recent please including courses currently attending please.
What days and times would best suit you and what is the maximum time you could offer to Home-Start as a volunteer on a regular weekly basis?(suggested up to 3 hours per week)
Could you commit to a minimum of 12 months of volunteering?
It will be necessary for you to visit families in the surrounding area
What type of transport would you use? / Do you have an available car you would be happy to use to get to and from venues? / Yes☐ No☐
Do you have a current, clean driving license? / Yes☐ No☐ / If no, please give details
What attracted you to show interest in volunteering for Home-Start Colchester?
Do you have any previous experience working/ parenting children? Please tell us here:
Do you have any previous experience supporting families? Please tell us here?
Please tell us about any paid voluntary work experience you have which may be relevant to this role
Have you any other skills or personal experiences which may be relevant to your work as a volunteer for Home-Start? (e.g. budgeting, cooking, DIY etc.)
What do you hope to gain form volunteering for Home-Start?
Is there any other information you would like to add?
Support and health needs
Do you consider yourself to have a disability or health condition or extra support need that we should be aware of and if so what adjustments could Home-Start provide to enable you to volunteer?
☐Yes ☐ No
If yes, please provide details on an additional sheet

As a family support charity, Home Start Colchester have a duty to protect the children, young people and families with whom we work and also to ensure that no one becomes a volunteer who misuse this trust. The volunteer role you have applied for will impact on what information you are required to disclose under the Rehabilitation of Offenders Act 1974 and or the Childcare Act 2006. Therefore, it is essential that you complete and sign this form.

The Disclosure and Barring Service has a guide which provides a simple and clear explanation of the disclosure application process. The guide can be viewed online at

As you will be completing an Enhanced Disclosure form detail of any criminal convictions or cautions found will be passed onto to Home-Start Colchester, therefore it is important that you provide details of all offences, penalties, and/or police enquiries and dates on a separate sheet of paper, in a sealed envelope, marked confidential, for the attention of the Volunteer Co-ordinator.

Have you ever been dismissed from any paid or voluntary work? / Yes ☐ No ☐
Have you ever been convicted of a criminal offence, or cautioned, reprimanded or given a final warning by the police (‘spent’ or ‘unspent’) please read the ‘criminal information’ guidance in the covering letter on which information to disclose before answering this question. / Yes ☐ No ☐
Are you disqualified from working with children or vulnerable/protected adults / Yes ☐ No ☐
Are you aware of any police enquiries following allegations made against you, which may have a bearing on your suitability for the role? / Yes ☐ No ☐
I understand that the relevant checks for the role I am applying for will be sought / Yes ☐ No ☐
Are you registered with the DBS Update service? / Yes ☐ No ☐
I know of no other reason why I would be unsuitable to be a Home-Start volunteer. I will report any changes in my circumstances which may affect my role / Yes ☐ No ☐
Data Protection
At Home-Start Colchester we value your support and promise to respect your privacy. The data we gather and hold is managed in accordance with the Data ProtectionAct (1998). We will not disclose, or share, personal information supplied by you with any third party organisation without your consent. We would like to keep you informed about the vital work we do and volunteering opportunities that may be of interest to you, however if you do not wish to receive this information please let us know by ticking this box ☐
Declaration
I understand and agree that data contained in this application form will be used for volunteer recruitment purposes and will be held on a computer database. I also agreed to Home-Start Colchester holding this form in paper format in a secure area.
I confirm that the information I have given is correct and complete and that any false statements or omissions may result in my services to be terminated.
I give permission for Home-Start to carry out criminal record checks at enhanced level with the appropriate agency.
I understand that my National Insurance number, passport and/or driver’s license may be required for identification purposes.
I understand that Home-Start may hold personal information about me in paper records and on their computer, including sensitive information such as age, race, sex and disabilities that they will use for their monitoring purposes. I agree to them holding this information and understand that it may be shared with Home-Start UK for Quality Assurance purposes.
I understand that I may ask to see my records at any time.
Signed:______
Print Name: ______Date: ______
Many thanks for taking the time to complete this form.
Please return your completed form to:
Home-Start Colchester, The Ark, Highwoods Methodist Church, Jack Andrews Drive, Colchester, Essex, CO49FF.
Or email to
Please contact the following person for any enquiries regarding your application to become a volunteer (name/telephone no/email address):
Home-Start ColchesterTel. No: 01206 865349 Email

Equal Opportunities Monitoring

You do not have to complete this part of the form but if you would like to do so, the information would be very helpful to us. The information will only be used to provide us with statistics to show us where we need to target our volunteer recruitment. This will help us to make sure that Home-Start Colchester welcomes volunteers from all areas of society, and will mean that we are a better able to help some of the most vulnerable children, young people and families in our area.

Are you

☐Male☐Female☐Transgender

How would you describe your cultural or ethnic origin?

A. White

☐British☐Welsh☐English☐Irish☐Scottish☐Northern Irish

☐Gypsy/Traveler☐Any other white background

B. Mixed

☐White & Black Caribbean ☐White & Asian☐White & Black African

☐Any other white background

C. Asian

☐Indian ☐Pakistani☐Bangladeshi☐Chinese ☐Any other Asian background

D. Black or Black British

☐Caribbean ☐African☐Any other black background

E. Other Ethnic Group

☐Arab ☐Any other ethnic background

Thank you for providing this information

Home-Start Colchester, a company limited by guarantee. Registered in England & Wales. Company No. 05706756 Registered Charity No. 1116639