SLEEP SAFE VOLUNTEER APPLICATION FORM 2017/2018( CompletedForms to be returned by 31 Sept 2017 )

( Mon 13thNovember 2017– Sun 18th March 2018 - 4 months provision )

Last Name: / First Name: / Title:
Address:
Post Code: / Email: @
Telephone: / Mobile:
Best time/day to contact you:
DOB: / / / Ethnicity (e.g. White British) / Gender:
Do you have transport: Yes / No
Please describe briefly why you are interested in becoming a Sleep Safe volunteer:
Were you a Sleepsafe volunteer last year yes / no
Training :
Have you attended any of the following FWW mandatory training in the last 12 months ?( Lastsleepsafe ?)
1)Safeguarding Adults Yes /no
2)Drugs & Alcohol Awareness Yes /no
3)First Aid Yes /no
If you have attended training for the above subjects other than through FWW please specify :
*All new volunteers need to attend the above mandatory training ( Block 1 Oct 17 ) See Training Programme
Please give your current employment/education status:
Employed: hours per week……………………….
In education: hours per week……………………
Not in work at present(please tick)……..
Retired(please tick)……..
Self-employed (please tick)…….. / Do you have any health issues which may affect volunteering?
Please tick which shifts you are interested in :
Host - Sleepsafe Shift Availability / Mon / Tue / Wed / Thu / Fri / Sat / Sun
Morning Shift (06.45 - 08.30)
Evening Shift (20.30 - 23.00)
Night Shift ( waking ) (23.00- 06.45)
I am available to work ……….. Shifts per week
Months available (please tick) / Nov / Dec / Jan / Feb / Mar
Please detail any unavailability (i.e. planned holidays)

------Office Use Only

Training Completed / Application Approved by
Reference 1check complete / Shift(s) Allocated
Reference 2 check complete / Application withdrawn / Date / /
CCPAS/DBS received / Applicant rejected/terminated / Date / /

REFEREES Please give the names and details of two referees – not family members or friends

1st Referee

Last Name: / First Name: / Title:
Address:
Post Code: / Email: @
Telephone: / Mobile:
Relationship (eg previous employer or minister)

2nd Referee

Last Name: / First Name: / Title:
Address:
Post Code: / Email: @
Telephone: / Mobile:
Relationship (eg previous employer or minister)
Do you have a current DBS / YES (please give details below) / NO
DBS Number: / Date issued / /
Organisation issued for:
I agree to my photograph being taken for publicity purposes YES / NO
Signature …………………………………………….. Date / /
I understand that I will not receive payment for this volunteer work. That the voluntary work is confidential and that my name and address will be retained on a computer database in the Faithworks office. Ultimately we reserve the right to ask you to leave the project if we do not think this type of volunteer work is suitable for you.
Signature………………………………………………….. Date / /

Please return this form to:

Faithworks Wessex

154A Seabourne Road

Southbourne

Bournemouth

BH5 2JA

Tel: 01202 429037

Homelessness Worker 07731858625