VOLUNTEER REGISTRATION FORM

PLEASE COMPLETE THIS FORM AND RETURN TO AMANDA COYLE AT: HEALTHWATCH, THE RIVERSIDE CENTRE, THE QUAY, NEWPORT, ISLE OF WIGHT, PO30 2QR

Role applied for: please delete as applicable

Enter and View Panel

Marketing and Communication

Healthwatcher

Name………………………………………………………………………………………………………………………………………

Home address………………………………………………………………………………………………………………………..

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

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

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

Phone………………………………………………………………………………………………………………………………………..

Mobile……………………………………………………………………………………………………………………………………..

Email………………………………………………………………………………………………………………………………………..

Proof of Identity x 2………………………………………………………………………………………………………………….

Are you willing to sign up to the principles of public life and personal code of conduct?

YES/NO

see Annex1

Employment history, please start with most recent first:

Please explain any gaps in employment:

Please tell us why you would like to volunteer with Healthwatch Isle of Wight:

Please give the name, role (if applicable) and address of two referees. These must not be people related to you:

Name / Name
Role(if applicable) / Role(if applicable)
Address
Postcode / Address
Postcode

NB: For Enter and View Panel Members a Declaration and Barring Service Check must be carried out for which further information and documentation may be required.

Signed………………………………………………………………………………………………..

Dated………………………………………………………………………………………………..

Annex 1

The Seven (Nolan) Principles of Public Life

Selflessness

Holders of public office should take decisions solely in terms of the public interest. They should not do so in order to gain financial or other material benefits for themselves, their family, or their friends.

Integrity

Holders of public office should not place themselves under any financial or other obligation to outside individuals or organisations that might influence them in the performance of their official duties.

Objectivity

In carrying out public business, including making public appointments, awarding contracts, or recommending individuals for rewards and benefits, holders of public office should make choices on merit.

Accountability

Holders of public office are accountable for their decisions and actions to the public and must submit themselves to whatever scrutiny is appropriate to their office.

Openness

Holders of public office should be as open as possible about all the decisions and actions that they take. They should give reasons for their decisions and restrict information only when the wider public interest clearly demands.

Honesty

Holders of public office have a duty to declare any private interests relating to their public duties and to take steps to resolve any conflicts arising in a way that protects the public interest.

Leadership

Holders of public office should promote and support these principles by leadership and example.