‘Great’ Volunteer
Personal DetailsTitle:......
First name:...... Surname......
Address1:......
Address2: ......
Town: ......
County: ......
Country: ......
Post code: ......
Telephone:...... Mobile:......
Email address:......
Previous name (where applicable):......
Town and county of birth:......
National Insurance Number:......
Are you eligible to work in the UK?......
Do you possess a current and valid driving license?......
Have you been convicted of a criminal offence, other than a spent conviction under the Rehabilitation of Offenders Act 1974?
(If yes, please give details below)
The company is committed to best practice in the recruitment and employment of disabled people. Please tell us below if there are any reasonable adjustments we need to make which would enable you to compete fairly for this job.
......
Why do you want to volunteer?What qualities and experience do you have that is relevant to this volunteering opportunity?
What are your expectations of this volunteering opportunity? (i.e what do you think you will be doing?)
Page 1 of 6 January 2015
AN EXAMPLE OF A FIVE YEAR CHECKABLE HISTORY AS REQUIRED BY THE CAA TO OBTAIN AN AIRSIDE AIRPORT PASS
DATE FROM / DATE TO / CONTACT NAME AND ADDRESS * / JOB HELD/COURSE TYPE/BENEFITS CLAIMED / REASON FOR LEAVING (IF APPLICABLE) / SUPPORTING (GAP) REFERENCE01/02/2010 / 15/09/2010 / British Plastics, 24 Evesham Way, Birmingham. B99 0QP
Mr David Hartley Tel 0121 999 1234 / Sales office / Made redundant
16/09/2010 / 23/11/2010 / Registered with Benefits Office, 27 Wheatley Way, Bromsgrove. B33 8EE
Tel 01527 99929 / Income support / Found Employment
24/11/2010 / 15/01/2011 / John Spencer Stores, 18 Park View, Birmingham. B88 9OP
Mrs Olive Oil Tel 0121 444 9909 / Clinique Counter Sales / Christmas Job
16/01/2011 / 14/09/2011 / RSPCD, 99 Doggie Way, Worcester.
Mr Clive Owen Tel 0905 444555 / Volunteer 4 hours per week / Volunteer / **Joanne Field, 77 Moor Lane, Birmingham B55 5RR
15/09/2011 / 27/08/2013 / Birmingham College of Dog Grooming, 27 Barkers drive, Birmingham B78 9KK
Miss Kay Nine Tel 0121 456 7890 / Training to be a dog groomer / Course finished
10/07/2011
11/07/2012 / 10/09/2011
11/09/2012 / RSPCD as above / College holiday, volunteer at RSPCD. Reference contact is the same as before / Holiday Work
28/08/13 / 19/10/14 / Travelling through Europe with friends / ***Brian Brown, 6 Marsh Road, Birmingham B99 0LK
20/0/14 / 15/12/14 / Registered with benefits Office,
15 Rowan Road, Redditch / Income support / Found Employment
16/12/14 / current / John Spencer Stores, 18 Park View, Birmingham. B88 9OP
Mrs Olive Oil Tel 0121 444 9909 / Menswear Counter Sales / Christmas Job
* Name and address of employer/school/college/benefits office. Please include the name of the person we should direct the reference to if known.
** In any position of work or study – if your hours of attendance are less than 15 hours per week we will need a second referee name. This person must be in full time employment or retired from such, and have known you for at least 5 years – they cannot be related to you or be married to a member of your family, they cannot be living at your home address.
***If you are not claiming benefits when not working (for longer than two weeks) you will need gap reference. This person must have regularly contact with you (at least once a month) and not be related or living at the same address. They must be in full time employment.
SECURITY 5 YEAR HISTORY (WITH NO GAPS)
DATE FROM / DATE TO / CONTACT NAME AND ADDRESS * / JOB HELD/COURSE TYPE/BENEFITS CLAIMED / REASON FOR LEAVING (IF APPLICABLE) / SUPPORTING (GAP) REFERENCEPage 1 of 6 January 2015
Character ReferencesPlease provide details of two character referees.
The criteria for a person confirming character of the applicant is as follows:
- over 18 years of age
- someone who has regular contact with you e.g. at least once a month (minimum requirement)
- has known you for a minimum of 5 years
- must be in full time employment
- is not a relative by blood or marriage nor be co-habiting with you.
- is not the sponsor of the pass application, nor an employee of the sponsoring company/third party/contractor
- may not be the same person that has been used previously as an employment referee.
REFERENCE 1
Name:......
Profession:......
Address:......
Town:...... County:......
Post code:......
Email address:......
Contact number:......
REFERENCE 2
Name:......
Profession:......
Address:......
Town:...... County:......
Post code:......
Email address:......
Contact number:......
DeclarationEqual Opportunities Monitoring
First Name(s):
Surname:
Date of Birth:
Position applied for:
Gender:
Do you consider yourself disabled? Yes No
Ethnic Origin:
How did you become aware of this opportunity?
Page 1 of 6 January 2015