Individual Work/Volunteer Registration Form

Part 1

Communication Details
Name: / Click or tap here to enter text.
Address 1 / Click or tap here to enter text. /
Address 2 / Click or tap here to enter text. /
Address 3 / Click or tap here to enter text. /
County / Click or tap here to enter text. / Postcode / Click or tap here to enter text. /
Landline / Click or tap here to enter text. / Mobile / Click or tap here to enter text. /
Work: / Click or tap here to enter text. / Email: / Click or tap here to enter text. /
Geographical area for volunteering:
Allerdale☐ / Carlisle☐ / Eden☐ / South Lakes☐ / All ☐
Volunteer Commitment / Full-time☐ / Part-time☐ / Short-term☐
What days/hours are you available to work?
Monday / 9am-5pm / ☐ / 9am-1pm / ☐ / 1pm-5pm / ☐ / 9.30-2.30 / ☐ /
Tuesday / 9am-5pm / ☐ / 9am-1pm / ☐ / 1pm-5pm / ☐ / 9.30-2.30 / ☐ /
Wednesday / 9am-5pm / ☐ / 9am-1pm / ☐ / 1pm-5pm / ☐ / 9.30-2.30 / ☐ /
Thursday / 9am-5pm / ☐ / 9am-1pm / ☐ / 1pm-5pm / ☐ / 9.30-2.30 / ☐ /
Friday / 9am-5pm / ☐ / 9am-1pm / ☐ / 1pm-5pm / ☐ / 9.30-2.30 / ☐ /
Saturday / 9am-5pm / ☐ / 9am-1pm / ☐ / 1pm-5pm / ☐ / 9.30-2.30 / ☐ /
Sunday / 9am-5pm / ☐ / 9am-1pm / ☐ / 1pm-5pm / ☐ / 9.30-2.30 / ☐ /
Other Details: / Click or tap here to enter text. /
Volunteer offer of support: / Individual or Team
Admin☐ / Warehouse☐ / Marketing☐ / IT☐ / Transport☐
Social Media☐ / Fundraising☐ / Grants☐ / HR☐ / Health & Safety☐
Promotion☐ / Training☐ / Legal☐ / Funding☐ / Stalls☐
Painters☐ / Decorators☐ / Gardening☐ / Plasterers☐ / Builders☐
Electricians☐ / Surveyors☐ / Van + Driver☐ / Labourers☐ / Plumbers☐
Confidential Personal Details
Do you have the right to work in the UK? / Yes☐No☐ / National Insurance Number: / Click or tap here to enter text. /
If you are not a UK/EU national, please detail the terms of your status blow:
Click or tap here to enter text. /

Please continue on the other side

*Ex-offenders are considered for employment on an individual basis.

Return to:CERT (UK) Ltd, The Former Engineering Labs, Skirsgill Depot, PENRITH, Cumbria CA12 2BQTel: 01768 593 190

Part 2 – CERT (UK) Ltd Individual Work/Volunteer Registration Form

Have you ever been convicted of a criminal offence which is not yet considered 'spent' under the Rehabilitation of Offenders Act 1974? / Yes☐No☐
Are you facing any criminal prosecutions? / Yes☐No☐
Have you ever received a police caution? / Yes☐No☐
If yes, please provide details: / Click or tap here to enter text. /
Our Community We believe we are better for being part of our community.
Have you ever been involved with any community or charity work? (Don't worry if not, we're just interested in knowing more about you.) / Click or tap here to enter text. /
How did you hear about us? / Click or tap here to enter text. /
Were you recommended by a current volunteer/employee? / Yes☐No☐
Have you attached your most current CV? / Yes☐No☐
Please enter details (name, address, phone and email) of up to 3 referees
in support of your application:
Reference 1
Click or tap here to enter text. /
Reference 2
Click or tap here to enter text. /
Reference 3
Click or tap here to enter text. /
CERT (UK) Good Practice Arrangements
  • Inductions
/
  • Disabled Access
/
  • Friendly environment

  • We pay 25p a mile travel
/
  • Disabled Toilets
/
  • Appropriate Training

  • We pay up to £3.00 Lunch claim
/
  • Kitchen facilities
/
  • Apprenticeships
    (subject to 16hrs of volunteering)

  • Equal Opportunities
/
  • Volunteer Insurance
/
  • Public Liability insurance

DECLARATION (Please tick to confirm)
I consent to CERT (UK) Ltd using and keeping information about me provided by myself
or a third party, such as references, relating to my application or future employment.* / ☐ /
I confirm the information provided is accurate and complete. I acknowledge that any false statement or omissions may disqualify me from taking up employment or render me liable for dismissal. / ☐ /
I consent to the use of my photograph taken by CERT (UK) or its authorised partnersfor marketing, promotion and social Media for CERT (UK) Ltd. / ☐ /

For Office Use Only

Application received on: / Application administered by:
Called for interview? / YesNo
References Taken? / Yes / No / Date: / Ref 1 / Ref 2 / Ref 3
Driver’s Licence Details Checked? / YesNo
DBS Check Required? / Yes / No / Passed

*Ex-offenders are considered for employment on an individual basis.

Return to:CERT (UK) Ltd, The Former Engineering Labs, Skirsgill Depot, PENRITH, Cumbria CA12 2BQTel: 01768 593 190