Thank you for expressing an interest in volunteering with Simon Community Northern Ireland. We will acknowledge your application form on receipt. Our Volunteer Coordinator will be in touch with you. We look forward to hearing from you. Please keep the coversheet attached to your application.

SECTION ONE: PERSONAL DETAILS (Please complete using block capitals and black ink)
Full Name
Address
Postcode
Contact Number / Email
SECTION TWO: VOLUNTEERING WITH SIMON COMMUNITY NI
Please tell us what role(s) you are applying for. / COMMUNITY CHAMPION
When would you be available to volunteer with us?
Mon / Tues / Weds / Thurs / Fri / Sat / Sun
Morning
Afternoon
Evening
Please select your preferred location / Northern (Ballymena, Coleraine, Derry, Larne) / Central
(Belfast) / Greater Central
(Carrickfergus, Holywood)
Southern (Armagh, Newry, Portadown) / South Eastern (Bangor, Downpatrick, Lisburn) / Western
(Cookstown, Enniskillen, Omagh)
Have you any previous experience of volunteering? If so please state when and where.
Please tell us what motivated you to apply to be a volunteer with Simon Community NI.
SECTION TWO: VOLUNTEERING WITH SIMON COMMUNITY NI (continued)
Please tell us what you hope to gain from volunteering with us.
SECTION THREE: ABOUT YOU
3:1 Experience: Please demonstrate how you meet the Experience section of the Volunteer Role Description.
3:2 Personal Qualities: Please demonstrate how you meet the Personal Qualities section of the Volunteer Role Description.
3:3 Skills: What skills or knowledge do you feel you could bring to a voluntary role in our organisation?
3:4 Interests: Do you have any hobbies or interests relevant to the post?
SECTION FOUR: SUPPORT NEEDS
Are there reasonable adjustments that we could make as part of your recruitment process that would enable you to enjoy equality of opportunity in seeking a volunteer role with us?
SECTION FIVE: REFERENCES
Please provide details of two referees. Where possible, one of these should be your current/ most recent employer or a University tutor. If these are not available, please contact our Volunteer Coordinator to discuss alternatives. Your referees should be in a position to assess your skill and knowledge in relation to the volunteering role you are applying for
REFEREE 1 / REFEREE 2
NAME / NAME
OCCUPATION / OCCUPATION
ADDRESS / ADDRESS
POSTCODE / POSTCODE
TEL NO / TEL NO
EMAIL / EMAIL
SECTION SIX: DISCLOSURE
Please note that convictions do not necessarily debar an individual from obtaining a volunteering position.
Have you ever been convicted of a criminal offence, which cannot be considered ‘spent’ under the Rehabilitation of Offenders Act (NI) Order 1978, amended in 2014?

If yes, please provide details:
SECTION SEVEN: DATA PROTECTION
At Simon Community NI, we value your support and promise to respect your privacy. Any information you provide will be held and managed in accordance with the Data Protection Act (1998). We will not disclose, or share, any personal information provided by you with any third party organisation without your consent.
The information provided on this form will be used in the recruitment and selection of volunteers and may be disclosed to all those who need to see it. It will also form the basis of a confidential volunteer.
We would like to keep you informed about the vital work we do and of further volunteering opportunities that you may be interested in. If you do not wish to receive this information, please tick this box.
SECTION EIGHT: DECLARATION

SIGNATURE DATE

Please send your completed application form by email or post to:

Volunteering, Simon Community NI, 25-27 Franklin Street, Belfast, BT2 8DS

FOR OFFICE USE ONLY
Interview Date
References Requested / Reference 1 / Reference 2
References Received / Reference 1 / Reference 2
Access NI Requested / Date Received
Induction Completed / Pre-volunteering Training Completed
Volunteer Agreement Signed / Volunteer Confidentiality Agreement Signed
Volunteer Start Date / PAMS Record Created

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