Flook House, Belvedere Road, Taunton, TA1 1BT

Flook House, Belvedere Road, Taunton, TA1 1BT

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01823 334244

VOLUNTEER REGISTRATION – Part 1

We are pleased that you have expressed an interest in becoming a volunteer with The ManKind Initiative. Please complete this form and return via post or email.

PERSONAL DETAILS
Title / Forenames / Surname
Previous names used (i.e. Maiden Names) Please include date changed)
Address
Postcode
How Long have you lived at this address?
If you have lived at this address for less than 5 years please include previous address in the box above
CONTACT DETAILS
Daytime Number / Mobile Number
Evening Number / Email Address
DOB / Place of Birth
Gender Male Female
Ethnic origin
(if comfortable to provide)
Do you have any criminal convictions other than motor offences? Yes / No
If “yes” please provide details of the offences and dates (note this will not prevent you accessing volunteer opportunities)
SKILLS & VOLUNTEERING
Please tell us how you heard about The ManKind Initiative?
Please tell us why you would like to volunteer with The ManKind Initiative?
Occupation(if retired please state previous occupation)
Please outline specific skills/interests you have to offer or would like to provide
Please tell us what kind of opportunity you are interested in?(please refer to list of opportunities, more than one may be selected)
Have you done any voluntary work before? Yes / No
If “yes” please provide details of the organization and role you performed
Please tell us what you would like to gain from volunteering
Please tell us what time you can give
Do you have any experience with victims of Domestic Violence or Abuse? Yes / No
If you are comfortable offering details please indicate below
Are you registered disabled? Yes / No
Do you have any health conditions which require reasonable adjustments to enable you to volunteer? Yes / No
(note this will not prevent you accessing volunteer opportunities)
Some of our volunteer opportunities require additional training:
Are you willing to attend a training sessions? Yes / No
Are you willing to travel, if necessary? Yes / No
CHARACTER REFERENCES
Please provide details of two people (not relations) who could provide a character reference for you. Contact with your referees will be in confidence and may be followed up with a telephone call.
Reference One
Name
Address
Postcode
Telephone Number / Reference Two
Name
Address
Postcode
Telephone Number
DECLARATION
I declare that to the best of my knowledge, the information provided above is true. I understand that any false declaration, misleading statement or any significant omission may disqualify me from volunteering. I understand that any offer is subject to satisfactory references and a probationary period and where appropriate satisfactory Disclosure and Barring Service (DBS) checks(requested on a separate form if required).
Signature: Date:

Data Protection – please refer to the separate sheet regarding how The ManKind Initiative will handle the data you have provided.

Updated 30 December 2015

Registered Charity No. 1089547 Registered Company No. 3869893Page 1