How Can We Contact You?

How Can We Contact You?

Volunteer Application Form

Title: / First name: / Surname:
Role you are applying for:
Where did you hear about the role?
Press Advert / Leaflet
Article in Newspaper / Referred by a friend
TV/Radio / Talk/Presentation
Exhibition / Donor/Drive
Poster
Other, please give details:

How can we contact you?

Address including your postcode
Telephone number
Email address
How would you like us to contact you?
Please circle / Email
Post
Phone

Emergency contact information

Name
Phone number
Relationship to you

Please tell us why you would like to volunteer with DKMS

Skills, qualities and experience. Please tell us about any skills, qualities and experience relevant to the role you are applying for using the role description to shape your answer.

Please tell us how you think the role will be of benefit to you.

Who can we contact as a referee? For some volunteer roles we ask that you provide details of a referee. The referee shouldn’t be related to you and, where possible, they should be someone who knows you in a professional capacity e.g. a tutor or colleague. Please check the role description for information on whether you need to provide details of a referee.

Name: / Phone number:
Address:
Email address:
Relationship to you:

Data protection

By signing this form you agree to us recording your details on our database so that we can provide you with the best possible support every time you contact us.

We will also keep you up to date from time to time about our work and how you can get more involved with our team. Your details will be kept securely and only shared within DKMS. We will never sell or swap your details with any third parties.

If at any point you want to update your contact details or change how we communicate with you the please contact the Senior Volunteer Manager on , telephone 020 8747 5652 or write to DKMS, Ashburnham House, Horticultural Place, Chiswick, W4 4JQ.

Declaration

I declare that to the best of my knowledge, the information I have given is complete and accurate and confirm that it may be processed and handled by DKMS under the principles of the data Protection act 1998.

I confirm I am over the age of 18 and understand this agreement to volunteer for DKMS is binding in honour only and is not intended to be a contract of employment. DKMS has permission to contact the referee I have provided (if applicable) and my volunteering with DKMS is subject to the reference being satisfactory.

Signed:
Date:

Please return this form to the Senior Volunteer Manager using the contact details below.

Post: Ashburnham House, Horticultural Place, London W4 4JQ

Telephone: 020 8747 5650

Email:

Confidential - Equal Opportunities Monitoring Form

We are collecting this information to enable us to monitor the diversity of our volunteer base and to ensure the effectiveness of our Equal Opportunities Policy. It will not be used in any other way. If you would prefer not to disclose any of this information, please tick the ‘prefer not to disclose’ box.

  1. Age ……………………………………………..
  2. Gender (Male/Female/Other/Prefer not to disclose )

……………………………………………………

  1. Do you consider yourself to be disabled?

The Equality Act 2010 describes a disability as a ‘physical or mental impairment that has ‘substantial’ and ‘long-term’ negative effect on your ability to do normal daily activities’. Please circle or tick.

Yes NoPrefer not to disclose

  1. Would you describe yourself as (tick box)

White / British
Gypsy
Irish
Any other white background
Mixed/multiple ethnic groups / Mixed – White and Black African
Mixed – White and Asian
Mixed – White and Black Caribbean
Any other mixed/multiple ethnic background
Asian/Asian British / Indian
Pakistani
Bangladesh
Chinese
Any other Asian background
Black / African
Caribbean
Any other Black/African/Caribbean background
Other / Arab
Other
Prefer not to disclose

Page 1 of 4