Volunteer Centre Dorset, The Coach House, Acland Road, Dorchester, Dorset, DT1 1EF

Tel 01305 269214

@VCDorset

Registered Charity Number 1113758 Company No 5685988

Volunteer Application Form

Date:………… Email ………………………………………………………………………. Post Code………......

Title: ………… Forenames:…………………………………….. Surname:…………………….…………..

Address:…………………………………………………………………………………………………………..…

……………………………………………………………………………………………………………………………

Telephone No …...... Mobile:…………………………………………………………

Date of birth………………….Age……..GenderMale FemaleTransgender Not Disc

Volunteer Agreement:I agree to potential placement organisations contacting me directly.– Join Volunteer Bank ……

I understand that some organisations will require references and/or police checks.I am willing to have my state of health and DBS status discussed with potential placement organisations. I accept the terms and conditions. (Copy available on request\online)

I consent to my details being held on our written and computer records.

(Your information will not be used for any purpose unrelated to the aims of the Centre)

Signed………………………………………Date………….. Interviewer………………………

How you heard about the centre

Careers Advice / VC Website / Job Centre / Library / Event
Recommended / VC Magazine / Colleague / Facebook / Media
Social Worker / Other Website / Passing By / Twitter / Friend
Outreach / County Council / District Council / Other

Tell us about any experience or personal qualities you have

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Areas of interest(Please Select three)

Animals / Families / Mentoring
Art, Design & Culture / Health, hospitals, hospices / Museums & Heritage
Children / Heritage / Music
Disability / Homeless & housing / Older People
Disaster Relief / Human & Civil rights / Poverty
Domestic Violence / International aid / Prisoners & ex-offenders
Drugs & addictions / IT, Computers & Technology / Race, ethnicity & Migration
Education & literacy / Legal & Justice / Religion/ Faith Based
Elderly / Lesbian, Gay, Bi & Transsexual / Sport & outdoor activities
Emergency services & Safety / Libraries / Women
Employment / Mental health / Youth*/Younger People
Environment & Conservation / Learning disability / Portland (ICA*)
Would you like to Mentor (one to one) someone with Learning Disability

Type of Activity(Please Select three)

Administration / Employee Volunteering / Marketing, PR& Media
Advice, information, support / Entertainment / Music
Art & Design / Environmental / Practical work & DIY
Befriending, buddying & Mentoring / Event volunteering / Retail charity shops
Building & Construction / Finance & Accountancy / Sport & Coaching
Business, management & Research / First Aid / Support Work
Campaigning & lobbying / Fund raising / Teaching & Training
Caring / Gardening / Trusteeships & Committees
Catering / General & helping / Under 16 volunteering
Community work / Hostels / Volunteer Management
Counselling / Languages & Translation / Youth work*
Driving (Full license required) / Legal

Skills that you have

Admin / Conservation / Cleaning & Tidying / Basic IT skills, Internet\Email / Reading and writing
Carpentry / Photography / Language skills / Organising & Planning / Creative & Design
Maths / Negotiating / Web Design / Bookkeeping & Finance / UK Driving License
Art & Crafts / Counselling / Managing People / Evaluating & Reviewing
Research / Gardening / Good IT skills / Building & Maintenance

Highest Qualification……………………………………………………………………………………

Available from:-………/………/……….Available for: One-off Roles Regular Roles

Availability / Mon / Tue / Wed / Thur / Fri / Sat / Sun
Morning
Afternoon
Evening

Ethnicity………………………….………Nationality…………………………………………..

Disability status: ……………….………….Disability Type: ………………………………………

Employment Status……………………….Immigration Status …………………………………..

If the applicant is under 18, Guardian/Parental consent is required before undertaking any voluntary placement

I consent to …………………………………… carrying out placement.

Signed………………………………………Print Name…………………………………

Do you have any health related issues that may affect your volunteering? PLEASE STATE

………………………………………………………………………………………………………………..

NOTES

------Office use only------

ENT VB / BY
( OWN ID) / DATE / LINK
ACTION / VC Email Address / Password

10/10/2018