Please State the Volunteer Role(S) That You Are Interested In

Volunteer Application Form

Please state the volunteer role(s) that you are interested in:

Preferred locations to volunteer in (tick as appropriate):

Across London / Lambeth / Lewisham / Southwark / Bromley / Bexley / Greenwich
Contact Details
Title:
Name:
Address:
Email:
Telephone:
Date of Birth:
Preferred method of contact:
Emergency Contact
Name:
Telephone:
Relationship to you:
Emergency Contact
Relevant Information

Please answer the following questions to support your application:

Why do you wish to volunteer for SELVIs?

What qualities, knowledge or skills might an effective volunteer, like yourself, bring to SELVis?

What interests, skills and experience do you have that might be relevant to the role? Please expand further in the box below:

Sport☐Drama☐IT☐Crafts☐Art ☐Cookery ☐ Literature☐ Outdoor Pursuits ☐Other ☐

Availability

Please indicate your availability and how regularly you wish to volunteer:

Mon / Tues / Wed / Thurs / Fri / Sat / Sun
AM
PM
Evening

Weekly☐Monthly☐One-off events☐

Disclosure

Due of the nature of our work with vulnerable adults, we need to know:

Do you have a criminal record*? YES ☐NO☐

*This includes ‘spent’ convictions as defined by the Rehabilitiation of Offenders Act 1974. We undertake a Disclosure and Barring Service Checks for all volunteers who will come into contact with SELVis service users.

If the answer is YES,we may wish to discuss this with you, it will not necessarily prevent you from becoming a volunteer. If you wish please give details below:

Monitoring

Do you consider yourself to have a disability or health issue that may require extra support while volunteering?

YES☐NO☐

If YES, please give further details:

References

Please provide details of two people who would be able to provide you with references covering the last 3 years:

Professional or Academic Reference / Personal Reference
(not a relative)
Name:
Email:
Telephone:
How do you know this person?
Declaration

I confirm that the information given on this form is correct to the best of my knowledge.

I understand that any offer of volunteering with SELVis is subject to satisfactory references and Disclosure and binding in honour only.

In accordance with the Data Protection Act 1998, I agree that SELVis may hold and use personal information about me for volunteering purposes and to keep in touch with me. This information, including that contained in this form can be stored on either manual or computer files. It will be held securely and only accessed by authorised personnel.

Signature ______Date______

Where did you hear about us? ______