1

TitleFamily name

First nameDate of birth

Address

CountyPostcode

Daytime telephoneMobile

Email

Why are you interested in volunteering for VRH?

What skills and attributes do you think you can offer?

Do you speak any languages other than English? Please specify

VOLUNTARY EXPERIENCE

Please describe your previous volunteering experience, if any:

2

OTHER EXPERIENCE

Please briefly describe your occupation and/or educational experience up to now:

AVAILABILITY

Please indicate how much time you can offer:

(Please see our website for the time commitment required)

Which areas e.g. boroughs, postcodes would be easy for you to reach?

HEALTH

We welcome applications from people with disabilities. A disability or health problem is unlikely to exclude you from volunteering but please give details if you have ever suffered from any disability or serious illness that could affect your volunteering. We may need to take up a medical reference but will seek your permission before doing so.

REFERENCES

Please provide two referees. They should not be family members or partners and ideally, they should be someone who has observed you working with children in a paid or non-paid capacity. We will also accept references from previous employers or someone in a professional capacity who has known you for at least two years. If personal circumstances make it difficult to provide these please discuss it with us and we will aim to find a solution. We will take up references prior to offering you a voluntary position.

Name

Address

PostcodeTelephone number

Relationship to you

Name

Address

PostcodeTelephone number

Relationship to you

V

DETAILS OF CRIMINAL CONVICTIONS

Volunteering with VRH is likely to give you the opportunity for substantial access to children and as such is exempt from the Rehabilitation of Offenders Act (1974). Please declare all convictions whether spent or otherwise. This information is necessary to safeguard this vulnerable group and will be kept confidentially. Please note we will also undertake security checks (Protection of Children Act 1999) for all volunteers with access to children.

Have you ever been convicted of a criminal offence? / Yes / No
Have you ever received a formal police caution? / Yes / No
Are there any matters pending which may result a criminal conviction? / Yes / No

Answering 'yes' to any of these questions will not necessarily prevent you from volunteering with VRH.

If you have answered 'yes' to any of the above questions please give details in a sealed envelope and attach it to your application, marking the envelope 'Private and Confidential'.

DECLARATION

I declare that the particulars I have given on this application form are correct to the best of my knowledge. Should I accept a voluntary role I understand that the information given in any part of my application will be retained and recorded within Volunteer Reading Help's personnel system. Under the terms of the Data Protection Act and the Data Protection Directive this information will be treated in a secure and confidential manner. However, I understand that Volunteer Reading Help may be required to give some of this information to the bodies responsible for regulating and/or funding Volunteer Reading Help's services.

Signature(please type your name if you are filling this out online)

Date

We would like to send you further details about how else you could get involved with the work

of Volunteer Reading Help. If you do not wish to receive this information please tick this box.

How did you hear about VRH?

Please either email this form as an attachment to or print and post to your local branch. For branch address details please see our website or contact central office.

Volunteer Reading Help Charity no. 296454

VolunteerEqualOpportunitiesMonitoringForm

PrivateandConfidential

Pleasecompletethisformandreturnitwithyourapplicationform.Pleasecompletethequestions

belowtohelpusmonitortheeffectivenessofourEqualOpportunitiesPolicy. Theinformationyou providewillbeusedforstatisticalpurposesonlyandwillbedetachedfromtheapplicationform.

NameDate of Birth

GENDERMaleFemale

ETHNICGROUP

Chooseoneselectionfroma)toe),thenticktheappropriateboxtoindicateculturalbackground

a)WhiteBritish Irish Anyotherwhitebackground

(pleasespecify)

b)MixedWhiteCaribbean WhiteAsian WhiteBlackAfrican

Anyothermixedbackground(pleasespecify)

c)AsianorAsianBritishIndian Pakistani Bangladeshi

Anyotherasianbackground

(pleasespecify)

d)BlackorBlackBritishCaribbean African

Anyotherblackbackground

(pleasespecify)

e)ChineseorChinese Anyother(pleasespecify)

otherethnicgroup

FAITH

Chooseonesectionfroma)toh),thenticktheappropriateboxtoindicatefaith.

a)ChristianChurchofEnglandCatholic ProtestantOther

(pleasespecify)

b)Buddhist c)Hindu d)Jewish e)Muslim f)Sikh

g)Noreligion h)Other(pleasespecify)

DISABILITY

Areyouregistereddisabled?Yes No