VOLUNTEER APPLICATION FORM

Please complete this application form in Black ink in full.

Note: applicants who submit part completed forms can not be considered.

If you have any special requirement with regards to the completion of this application form please do not hesitate to contact Volunteer Services on 0151 482 8986

Title ………………………………….
Last Name ………………………………………………………………………………………………………….
First Name(s) ………………………………………………………………………………………………………….
Address ………………………………………………………………………………………………………….
……………………………………… Postcode………………………………………..
Home Tel: …………………………………………….. Work Tel: ……………………………………………
Mobile No: ……………………………...... E-Mail : ………………………………………………
Occupation ……………………………………………

Please tick boxes to indicate which area of the Hospice you are interested in applying for:

Hospice □ Fundraising □ Hospice Gift Shop □

Community Charity Shops□ Please specify location

Please state any particular role you wish to be considered for and indicate any past achievements, employment, volunteering or personal qualities relevant to that role

______

______

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Please state why you want to volunteer for Wirral Hospice St John's

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______

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Please indicate below the days & times when you would normally be available to volunteer:

Mon / Tues / Wed / Thurs / Fri / Sat / Sun
9am to 1pm
1pm to 5pm
5pm to 9pm

REFERENCES

Please give details of two persons (not related to you) and including apast/ present employer where possible.

Name……………………………………...... Name……………………………………………………

Designated/Title………………………………… Designated/Title……………………………………….

Address………………………………………….. Address…………………………………………………

……………………………………………………. …………………………………………………………..

Postcode………………………………………… Postcode………………………………………………..

Tel No: ………………………………………….. Tel No: ………………………………………………….

Have you any previous Hospital / Hospice experience? Yes/No

In what capacity…………………………………………………………………………………………………..

Do you require a work permit to work in the UK?Yes / No

Do you have the legal right to work in the UK?Yes / No

If ‘Yes’ and there are conditions attached, eg start or finish dates, please specify

………………………………………………………………………………………………....

DISCLOSURE & BARRING SERVICE

All posts within the Hospice are subject to a Standard / Enhanced / Enhanced with check against the barred list, at a level appropriate to the role applied.

Do you have any unspent convictions, cautions, reprimands or warnings? Yes/No

REHABILITATION OF OFFENDERS (1974 Act)

Exception Order 1975 (2013)

The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are protected and are not subject to disclosure to employers and can not be taken into account. Guidance and criteria on the filtering of these Cautions and Convictions can be found on the Disclosure & Barring Service website

Criminal records will be taken into account for recruitment purposes only when the conviction is relevant.

A criminal record will not necessarily be a bar to obtaining a position.

PROFESSIONAL CONDUCT

Are you currently the subject of any investigation or proceedings by any body having regulatory functions in relation to health / social care professionals including such a regulatory body in another country? Yes/No

Have you ever been disqualified from the practice of a profession or required to practise it subject to specified limitations following a fitness to practice investigation by a regulatory body, in UK or another country Yes/No

Professional Misconduct will be considered carefully at recruitment and will not necessarily be a bar to obtaining a position. You will be required to give full details of the above at interview.

DECLARATION

I declare that the information contained in this form is true and complete. I understand that if it is subsequently discovered that any statement is false or misleading the Hospice has the right to dismiss me from volunteering duties. I also understand that any offer is subject to satisfactory references, disclosure and barring service check and production of requested documentation.

Signed……………………………………………… Date………………………………………

Please return by:
  • Post to The Volunteer Services Manager, Wirral Hospice St John's, Mount Road, Higher Bebington, Wirral, CH63 6JE
Or
  • Email