Education, Professional and Other Qualifications and Training

Private & Confidential

Wycombe Mind

Volunteer Application

Personal Details

Forenames:
Surname:
Address:
Postcode:
Home Telephone:
Mobile Telephone:
Email address:

Education, Professional and other Qualifications and Training

Name of school, University, College
or other institution. / Start date / End Date / Qualifications obtained with grades, membership of professional organisations, etc.

Career History

Please give details of all full-time or part-time work including voluntary roles in reverse chronological order starting with the current or most recent employer.

Employer’s name, address and type of business / Start date / End date / Job Title / Reason for Leaving

Reason for applying and additional information

Please use this section to tell us why you are applying to volunteer with Wycombe and to let us know about any additional experience or skills you would bring to the role.

References

Please give the names and addresses of two referees who are able to provide details of your experience, qualifications and suitability for voluntary work with Wycombe Mind.

Name:
Organisation:
Position:
Address:
Telephone no:
Email address: / Name:
Organisation:
Position:
Address:
Telephone no:
Email address:

Criminal Convictions Declaration

Rehabilitation of Offenders Act, 1974 (Exceptions Order 1975)

Have you ever been convicted of a criminal offence?

Yes / No

If yes, please give particulars. Because of the nature of the work for which you will be involved, you must provide information about convictions under the provision of the Rehabilitation of Offenders Act, 1974. In the event of being accepted by Wycombe Mind any failure to disclose such conviction could result in your being asked to leave. Any such information given will be treated in complete confidence.

Date / Place / Type of Offence / Fine Imposed

A Criminal Records Bureau Check will be needed in order to volunteer at Wycombe Mind.

Availability

Please note that our main need for volunteers is in our Social Care Day Service on Mondays, Tuesdays, Fridays and Sundays. We cannot offer counselling shadowing or placements.

Please tick to indicate your availability.

Monday
10am -2pm / Tuesday
10am -2pm / Friday
10am -2pm / Sunday
12-3pm
Tick if available:
Please state if you are only available at other times:

For how long do you anticipate you will you be available to volunteer? Please tick one.

Until I get a job or another more suitable volunteer position.
For the next month.
For three to six months.
For six months to a year.
For over a year.
Other (please specify)

Declaration

To the best of my knowledge the information I have given on this application form is correct. I understand that the provision of false information may result in disqualification or the termination of voluntary work.

Signed: / Date:

Thank you for applying to be a volunteer at Wycombe Mind.

If you have any questions about the application process please contact

01494 448279 or email

Please return your completed application form to:

Wycombe Mind Recovery Centre,16-18 Easton Street,High Wycombe,Bucks,HP11 1NR