Lewisham and Southwark

Stones End Day Centre

11 Scovell Road

London

SE1 1QQ

Dear Volunteer Applicant,

Re: Volunteering as a Keyworker at Stones End Day Centre

Thank you for your interest in volunteering at Age UK Lewisham and Southwark’s Stones End Day Centre as a Keyworker. We are a busy community space that depends on great volunteers to provide direct support to people attending the centre.

The people we support should feel welcomed, encouraged to take part in activities and be a part of the centre.

As a volunteer you should be reliable, proactive and available at least 3 hours per week for minimum 3 months.

The role includes:

-Person centred support to a maximum of 5 older people with substancial care needs

-Refering & Signposting service users to a variety of Social Care services available

-Reviewing the support needs and individual care plans offered to Stones End service users

-Updating service user records with important and vital information so it is readily available and accessible to day care staff.

How we will support you:

- We will contribute to your travel and lunch expenses if you volunteer for more than 4hours with us

- We will inform you of training, volunteering and paid opportunities

- We hold regular volunteer socials so we can say thank you to our volunteers and for our volunteers to meet other volunteers across the organization

- We will provide you with a reference.

If you are still interested in volunteering with us, please complete the attached application form and equal opportunities monitoring form and return to me so we can proceed with your application.

Kind Regards,

Ms Helen Mangan

Stones End Volunteer Coordinator

Direct Line: 020 7358 4056

Email:

Age UK Lewisham and Southwark

Stones End Day Centre

11 Scovell Road

Southwark

London

SE1 1QQ

Tel: 020 7358 4056

Email:

STONES END DAY CENTRE

VOLUNTEER APPLICATION FORM

Please complete this form in BLOCK CAPITALS or black ink.

Personal Details:

Name:
Address:
Postcode:
Mobile:
Home:
Work:
Email:
What position are you applying for?
How did you find out about this opportunity?

Employment Status

Not in work
Registered Unemployed
Retired
Student
Working part-time
Working full-time
Carer
Other (please specify)

What do you hope to gain from volunteering on this project?

Please detail any qualifications or experience you have that is relevant to the post:

What skills and experience could you bring into the post?

Your availability

Ideally, how many days a week would you like to volunteer on the project and for how long?

Do you have any commitments that will affect your availability during your placement? E.g. holidays

Disclosure and BarringService

I agree that should I be successful in this application, I give my permission for Age Concern Lewisham and Southwark (ACLS) to apply to the Disclosure and Barring Service for an enhanced disclosure. I do understand that should the disclosure not be to the satisfaction of Age Concern Lewisham and Southwark any offer of a volunteer placement may be withdrawn or terminated. I also understand that I may be subject to a Home Office check.

References

Please provide contact details of two referees. At least one person should be of professional standing and they should not be a family member.

If your circumstances mean that you are unable to provide current references, we will be happy to discuss this further with you.

Name:
Address: / Name:
Address:
Relationship to you: (e.g. former employer, friend, neighbour)
How long has this person known you? / Relationship to you: (e.g. former employer, friend, neighbour)
How long has this person known you?
Telephone no:
Email: / Telephone no:
Email:

Data Protection Act 1998

Information on our database is strictly confidential and we do not pass on any personal data about you to outside organisations and/or individuals without your express personal consent. The only exception to this might be if there is a crisis and the emergency services need to be given appropriate information.

I agree that Age Concern Lewisham and Southwark may keep basic information from this form on record andoccasionally send you information updates about Age Concern Lewisham and Southwark.

Volunteer declaration

The information given in this application is, to the best of my knowledge, true and accurate.

Signature:

Date:

Please return the completed form to Helen Mangan at

E:

A: Stones End Centre,11 Scovell Road, LondonSE1 1QQ

Equality and Diversity Monitoring

Age UK Lewisham and Southwark aims to provide equal opportunities and fair treatment for all staff and volunteers.

Please complete the form and email or post to the address at the end. The information below is anonymous and will not be stored with any identifying information about you. All details are held in accordance with the Data Protection Act 1998.

We would like you to complete this form in order to help us understand who we are reaching and to better serve everyone in our community. The information will be used to provide an overall profile analysis of our staff and volunteer base.

Ethnicity

Please state what you consider your ethnic origin to be. Ethnicity is distinct from nationality and the categories below are based on the 2001 Census in alphabetical order.

Asian / Black / Chinese or other ethnic group
 Indian / Caribbean /  Chinese
 Pakistani /  African /  Any other ethnic group (please write in)
 Bangladeshi /  Any other Black background
 Any other Asian background / (please write in)
(please write in)
Mixed / White
 White and Black Caribbean
 White and Black African /  English
Irish
 Scottish / Rather not say
 White and Asian / Welsh
 Any other mixed background
(please write in) /  Any other White background
(please write in)

Age: ______ Rather not say

Disability

The Disability Discrimination Act 1995 (DDA) defines a person as disabled if they have a physical or mental impairment which has a substantial and long term (i.e. has lasted or is expected to last at least 12 months) adverse effect on one’s ability to carry out normal day-to-day activities. This definition includes conditions such as cancer, HIV, mental illness and learning disabilities.

Do you consider yourself to have a disability according to the above definition?

 Yes No Rather not say

Gender

 Male /  Rather not say / Transgender
 F to M
 M to F
 Female

Faith

Which group below do you most identify with?

 No religion / Baha’i /  Buddhist
 Christian /  Hindu / Jain
 Jewish /  Muslim /  Sikh
 Other (please write in) /  Rather not say

Sexual orientation

How would you describe your sexual orientation?

 Bisexual /  Gay man /  Heterosexual or ‘straight’
 Lesbian /  Other /  Rather not say

Date:

Thank you for completing this form.

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