Please complete this form in full in black ink pen or typescript.

Post: / DVRAP (Domestic Violence and Relationship Abuse Project) Volunteer - Ealing
1. Personal information
Surname: / Forenames:
Known as:
Permanent address:
Contact details:
Home: / Work:
Mobile: / E-mail address:
Please tell us if you have any preferences for how we contact you (for example, if you do not want to receive telephone calls in the evening).
2. References
Please give details of two people (not friends/family members) who have known you for at least two years and could provide a reference.

Present/most recent employer

/

Second referee

Name: / Name:
Address:
E-mail address: / E-mail address:
Telephone number: / Telephone number:
How do you know this person? / How do you know this person?
3. Education
Please give relevant details of education and qualifications, including current/proposed courses.

Schools/colleges/universities

/
Qualifications
4. Other training
Please give details of other training undertaken and any membership of professional associations.
5. Employment History
Please list employment and volunteer roles starting with your most recent post:
Job title and name of employer and employment dates /

Brief description of main responsibilities

6. Languages
Please tell us if you are fluent in any language other than English

7. Experience and abilities – shortlisting criteria

When completing this section, please describe your relevant experience or abilities. You should give clear, specific examples of what you have done or achieved. You may draw these examples from previous employment, voluntary or community work, spare time activities, training, or any other areas that you think might be relevant.

Please demonstrate your understanding of domestic violence and relationship abuse and the impact it has on children and young people.

Please demonstrate your experience of working with children and young people.
Please tell us briefly why you are interested in becoming a DVRAP volunteer.
8. Supporter Membership
Anyone volunteering for Victim Support can become a supporter member of our charity. Supporter members can put themselves forward or nominate other supporter members to sit on a national advisory group called ‘the Assembly’ and influence Victim Support’s work both locally and nationally. All volunteers are automatically registered as supporter members unless they opt out by ticking the box below.
I do not want to be a supporter member 
9. Communications
Supporter members also get a copy of our quarterly national newsletter Support Network and receive other communications from time to time.
If you do not want to receive these communications, tick here 
Victim Support uses email to communicate with its volunteers on a regular basis. Please let your local manager know if you do not have access to email.
10. Additional Information
Are there any dates when you would be unavailable to attend an interview?
Are you able to attend trainingon 2014? 6th, 13th, 27thFebruary and 5th and 6thMarch 2014 (DATES TO BE CONFIRMED).
How did you find out about this vacancy?
We ask everyone who wants to volunteer for our charity to disclose all convictions, including spent ones, at this stage. We will also ask you to complete a Disclosure and Barring Service check. Work as a volunteer for Victim Support is covered by the exemption order of 1975 relating to section 4(2) and section 4(3b) of the Rehabilitation of Offenders Act 1974. The information you give us will be held in strict confidence. Please note that if you do have a criminal record you will not be automatically excluded from volunteering.
Do you have any criminal convictions/cautions? / Yes/No
If ‘YES’ please give details in a separate letter and send this with your application form in an envelope marked ‘Confidential’. Please be aware that if you do hold a criminal record, you will not automatically be excluded from volunteering.

11. Declaration

I declare that the information given on this form, and on any accompanying documents, is true to the best of my knowledge and belief. I agree to complete a Disclosure and Barring Service (DBS) checkfor the purpose of obtaining information about any past convictions etc. I agree to the content of this form and consent to Victim Support holding and using my data in connection with supporter membership and agree to my equal opportunities data being retained for monitoring purposes.

Signed...... ………………...……………

Date:...... ….....…………………

Please return your completed application either by:

Email

Note: If you do email your application,please state thepost you are applying for in the subject of your email. For example, “DVRAP Volunteer”

Or mark it ‘Confidential’ and post it to:

DVRAP Team

Victim Support

51b PhilbeachGardens

London

SW5 9EB

Equal Opportunities Monitoring Form
In order to ensure that Victim Support continues to develop its declared equality and diversity commitments, all job applicants are asked to answer the questions below. This information will be treated as confidential and will be used for monitoring purposes only. The form will be separated from the application form on receipt at the recruiting office before short-listing of candidates takes place. The selection panel will not see this form.

If you prefer not to disclose any of this information, please leave the relevant section(s) blank.

Post applied for:Locality Project Manager – Relationship Abuse Project

How did you find out about this vacancy? (please tick one box only)

National press / Victim Support website
Local press / Jobs in Charities website
Other (please describe)
I would describe my ethnic origin as (please tick one box only):
Please tick this box if you would prefer not to answer this question:
Asian or Asian British / Black or Black British
Indian / Caribbean
Pakistani / African
Bangladeshi / Any other Black background
Chinese / (please describe)
Any other Asian background
(please describe)
White
British/English/Welsh/Scottish/Northern Irish
Irish
Gypsy or Irish Traveller
Any other white background
(please describe)
Mixed / Other ethnic group
White & Black Caribbean / Arab/Middle Eastern
White & Black African / Any other background
White & Asian / (please describe)
Any other mixed background
(please describe)
I would describe my religious group as (please tick one box only):
Please tick this box if you would prefer not to answer this question:
Christian (all denominations) / Sikh
Buddhist / Hindu
Jewish / Muslim
Other religion (specify below) / No religion
I would describe my sexual orientation as (please tick one box only):
Please tick this box if you would prefer not to answer this question:
Heterosexual / Lesbian
Gay / Bisexual / Other
I would describe my marital status as (please tick one box only):
Please tick this box if you would prefer not to answer this question:
Married / Single / Partner
Civil partnership / Co-habiting / Separated
Divorced / Widow / Widower
I would describe my gender as (please tick one box only):
Please tick this box if you would prefer not to answer this question:
Male / Female / Transgender
My age group is (please tick one box only):
Please tick this box if you would prefer not to answer this question:
under 16 / 16-24 / 25-34 / 35-44
45-54 / 55-64 / over 65
I consider myself to have a disability (please see Guidance notes for applicants):
Please tick this box if you would prefer not to answer this question:
Yes / No

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