Application to Volunteer

Please complete every section

Name:
Date of birth: / National Insurance No:
Address:
Post Code: / Telephone No
Home:
Work:
Mobile No:
Email:
Emergency Contact Name:
Phone No:
Please tick the statement below that applies to you:
I am not aware of any health conditions or disabilities which might impair my ability to undertake effectively volunteer duties.
I do have a health condition or disability which might affect my volunteer duties and which might require special adjustments to my volunteering or at my place of volunteering
Sussex Partnership actively encourages people who experience mental health problems to volunteer with us. As part of the application process we ask everyone whether any health problems they have may affect their volunteering and if they answer yes, work with them to find the best way of supporting them.
Exemption under the Rehabilitation of Offenders Act applies
Have you ever been convicted or cautioned in connection to an offence?
Yes / No
An enhanced Disclosure & Barring Service check is required for all volunteers, we will contact you about undertaking the check when we receive your application – a criminal record does not necessarily exclude you from volunteering with us.
Please provide details of two people who may be approached for a character reference and who know you well in either a personal or professional capacity (cannot be a family member).
Name:
Address:
Email: / Name:
Address:
Email:
How did you find out about our volunteer service?
Why do you wish to be a volunteer?
If you have already agreed a volunteer placement or are interested in one of the trust’s advertised volunteer vacancies please fill in the details here and if available the name of the staff member you have discussed it with and skip to the signature section
If you have not agreed a placement please tell us about the skills and experience that you have to offer – these might be from previous employment, voluntary roles, things you do in your spare time, caring responsibilities, etc.
What town, city or geographical area would you would like to volunteer in?
What time commitment can you offer us – please tell us the days/times/period? Please note a minimum of 5 hrs per week for 6 months is required.

Do you have a current driving licence and access to a car?

Yes / No
Please indicate if you interested in any of the following type of volunteering roles
Befriending
Arts and craft
Helping in groups
Gardening
Sport
Other – tell us if you have any specific skills you would like to offer / Administration
Ward assistant
Meet and greet/ reception
Kitchen Assistant
Chaplaincy
Please indicate which areas interest you
Children & Young People’s Services
Adult Mental Health Services
Dementia Services
Any / Substance Misuse Services
Learning Disability Services
Secure & Forensic Services

Are you interested in becoming a member of Sussex Partnership Trust?

By signing up as a member you will be showing support for the services we provide and the people we care for. Our members shape what we do in Sussex Partnership and how we do it. Membership is free and each member decides how much they want to be involved.

Yes / No

If you are interested in becoming a member, would you also be interested in any of the following?

Giving your views on any future service plans
Standing for election as a Governor
Attending members meetings or events
Signature: / Date:

Please return to

Volunteer Team, Aldrington House 35, New Church Road, Hove, East Sussex, BN3 4AF or email

As an NHS Foundation Trust we are committed to involving everyone and making sure that we offer all communities the opportunity to use our services. We would value your help by letting us have the information asked for below.

With this information we can make future improvements to our services by responding to the needs of local people. The answers you give are very important to us and will be kept confidential in accordance with the Data Protection Act.

Please answer the following questions on both sides by ticking the box to the left of the category that matches most closely how you identify yourself:

Please tick ANY that best describes you

Service User Carer Staff

1. What is your gender?

Male Female

2. Are you or have you ever considered yourself as Transgender

Yes No

3. What category best describes your Ethnicity?

A White

British Irish Gypsy or Irish Traveller

Any other White background

B Mixed / Multiple Ethnic Groups

White White White

& Black Caribbean & Black African & Asian

Other Mixed / Multiple Ethnic group

C Asian / Asian British

Indian Bangladeshi Pakistani Chinese

Other Asian background

D Black / Caribbean / African / Black British

African Caribbean Other Black/Caribbean/African Background

E Other Ethnic Group

Any other ethnic group, please state:

4. Please tell us what category best describes your Religion or Belief

Agnostic Baha’i Chinese (Taoist) Hindu

Atheist Buddhist Christian Humanist

Japanese Jewish Muslim Pagan

(Shinto)

Rastafarian Sikh Spiritualist Prefer not to say

Other, Please state

5. Do you have a disability, if so can you identify from the list below?

I do not have a disability Mental Health

(Inc. depression or anxiety)

Dyslexia Learning Disability

Unseen Disability

(E.g. diabetes, epilepsy, asthma, HIV, cancer)

Deaf / Hard of hearing Blind / partially sighted

Asperger’s syndrome / autism Wheelchair user /

Mobility Impairment

Other, please state

Prefer not to say

6. Which of the following best describes your Sexual Orientation?

Heterosexual Lesbian Gay

Bi-Sexual Prefer not to say