Volunteer Counsellor Training Application Form

Surname: ______Forename (s): ______

Date of birth: ______Mr/Mrs/Ms/Miss (delete as necessary)

Address: ______

______

______

Tel No: (Home) ______(Work) ______

(Mobile) ______

Email: ______

  1. Educationaland Professional Qualifications (please include any ongoing qualifications)
  1. Please give previous experience of voluntary work
  1. Please give details of any other volunteering placements you have or intend to have over the next 18 months (if applicable)
  1. Do you speak any other languages? If yes, please state
  1. Do you have any medical conditions that may affect your work as a volunteer? If yes, please state
  1. References:

Please provide names and addresses of two referees, one of who has known you personally for two years or more. (Please exclude family members).

Name: ______

Address: ______

______

______

______

Tel: ______

Email: ______

Relationship to applicant: ______

This placement will be subject to a DBS check.

Have you ever been dismissed from any paid or voluntary work?Yes / No

Have you ever been convicted of a criminal offence?Yes / No

Are there any matters outstanding which may lead to a criminal prosecution?Yes / No

If you have answered yes to any of the above questions, please give details

7.How did you hear about volunteering for BBS?

Rehabilitation of Offenders Act 1974

Because of the nature of the voluntary work for which you are applying, the post is exempt from the provisions of Section 4 (2) of the Rehabilitation of Offenders Act 1974, by virtue of the Exemption Order 1976.

Applicants must therefore not withhold information about any court conviction you

have received at any time, regardless of whether the conviction is deemed spent. If you

are successful in becoming a volunteer for BBS any failure to disclose such convictions could result termination of your voluntary work with BBS.

Any information given will be completely confidential and will only be considered in

relation to an application for positions to which the order applies.

DECLARATION: I declare that the above information is true and complete. Iunderstand that any false information may result in termination of my work with BBS.

Signature …………………………………………… Date ……………………………

Bradford Bereavement Support has been registered with the Criminal Records Bureau as an organisation working with vulnerable adults and so all staff and volunteers are required to be police checked.

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