VOLUNTEER APPLICATION FORM

Please return this form to:

Volunteer Coordinator.

200, Rookery Lane.

Walsall. West Midlands. WS9 8NP.

Tel: 01922 638825

Email:

Title / Mr / Mrs / Miss / Dr / Other / Full Address
Surname
Forenames
Telephone No / Home:
Mobile:
Email address
Preferred method of contact Email Phone Mobile
When are you available for volunteering?
AM / PM / Evening
Mon
Tues
Wed
Thurs
Fri
Sat
Sun
/ How many hours/days can you volunteer per week?
When will you be able to start volunteering?
Date:
Please give details of work experience, paid or voluntary and any qualifications gained that would be appropriate to the post(s) applied for.
Why do you want to volunteer for Age UK Walsall?
What do you hope to gain from your time spent Volunteering with Age UK Walsall?
Car driver? YES NO Access to a car? YES NO
Do you speak any languages other than English? (If yes, please list)

References

Please give the contact details of two people who have known you for at least two years. These must not be family members. References will be applied for on receipt of application unless you ask us not to. Please tick box to agree to us doing this □

Name / Name
Address / Address
Post code / Post code
Telephone No
Email / Telephone No
Email
Where did you hear about “Volunteering for Age UK Walsall”
Press Ad. Poster Promotional Event Leaflet Talk/presentation TV/radio Friend Other (Please specify )______
Which Role* would you be interested in Volunteering for? (please tick all boxes that apply)
Friendship Support Scheme o Hospital Volunteer o Telephone Befriending o Minibus Driver o Falls Prevention Ambassador o IT Class Volunteer o
Administration o Other (Please specify)______
*Please visit our website www.ageukwalsall.org.uk or see our Volunteering Opportunities leaflet for further information about these roles.
All volunteers are expected to regularly attend the training/meetings offered.
If accepted as a volunteer would you be willing to attend volunteer training/meetings?
YES NO
Most of our roles are eligible for a Disclosure and Barring Service check. Organisations are entitled under the Rehabilitation of Offenders Act* to ask the following question – and the potential volunteer is required to answer:
Do you have any convictions, cautions, reprimands or final warnings YES NO
which would not be filtered in line with current guidance?
If you answered yes, please specify:

If the volunteering role you are applying for involves contact with vulnerable people or confidential records, do you agree to a disclosure from the Disclosure and Barring Service being obtained? The level of DBS disclosure will depend on the volunteer role.
YES NO
DBS check under Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment) (England and Wales) Order 2013
*The amendment to the Exceptions Order 1975 (2013) provides that certain spent convictions and cautions are not subject to disclosure – and cannot be taken into account. Guidance may be found: www.gov.uk/government/publications/dbs-filtering-guidance

Data Protection The data provided on this form will be used by Age UK Walsall for the purposes of supporting our volunteers – and administering, evaluating and monitoring the quality of our volunteer management. We shall use the information you have supplied to us in line with Data Protection Guidelines. Please refer to Age UK Walsall Volunteer Recruitment Privacy Statement May 2016. Information held by Age UK Walsall is strictly confidential and we do not pass on any personal data about you to organisations and / or individuals without your consent.

I confirm that the information I have supplied on this application is correct.

Signed …………………………...... Date ………………