Open Country Volunteer Application Form

Open Country Volunteer Application Form

Confidential

Thank you for applying to become a volunteer with Open Country. For the safety and security of yourself and those you will be helping, we need some information for our records.

Please complete the blank sections below:

Name:______

Address:______

______

Postcode:______

Telephone:______

E-mail address:______

Where did you first hear about us? ______

What interests or work experience do you have relevant to Open Country?

______

Do you have a full, current driving licence?YesNo 

As volunteers work with vulnerable people, we ask for two references from people who have known you for at least a year (not family members). We will write to them to request a written reference.

Please give the names and addresses of two people who can give references for you:

Open Country Equal Opportunities and Confidentiality Statement

Volunteer’s Copy. Please keep this copy for your own records.

Equal Opportunities Statement

Open Country strives to provide opportunities for all sections of the community to volunteers on the various activities organised by the project.

All persons applying to volunteer with Open Country and all accredited volunteers will be given equal opportunities irrespective of their race, sex, sexual orientation, marital status, any or no religion, home circumstances or disability.

Open Country works to provide opportunities for people who cannot usually get into the countryside. It is expected that volunteers will not treat any participant less favourably on the grounds of their race, sex, sexual orientation, marital status, any or no religion, home circumstances or disability.

Confidentiality Statement

Due to the nature of the activities Open Country organises, it is necessary to have personal information and relevant medical information about people to ensure their safety and in case of emergency. Activity leaders are given access to information about participants on the activity they are leading.

All information is treated as confidential unless there is an emergency requiring disclosure to medical personnel or emergency services.

Due to the social and relaxed nature of Open Country activities, volunteers, may sometimes be told personal and private details by participants.

Volunteers are expected to respect the confidentiality of people involved in Open Country, and not to disclose any information to which they are given access, either written or verbal.

In the event that a volunteer is given information which causes concern for someone’s safety to well being, please notify the Open Country Project Officer as soon as possible. If there is an immediate concern for someone’s safety, ring the duty social worker for NYCC Social Services Dept.

I have read and understood the above statements.

Date…………………………………………………..

Please print your name…………………………………………………………………………

Please sign your name…………………………………………………………………………..