Volunteer Application Form – CONFIDENTIAL

Please complete in black pen.

Your personal details

Surname: / First Names:
Title:
Address:
Postcode:
Telephone Number: (Home) / Telephone Number: (work)
Mobile Number: / Email address:

Your skills and abilities

Do you hold a current UK driving licence?NoYes

Do you have access to transport?NoYes

Please tick your particular interests/skills:

Administration Advice services Befriending

Data EntryDIYFundraising

GardeningITOrganising events

Reception duties Teaching IT

Other (please specify)......

Hours available (please tick)

Mon AM / Tues AM / Weds AM / Thurs AM / Fri AM / Weekends
Mon PM / Tues PM / Weds PM / Thurs PM / Fri PM / Evenings

Previous Work / Volunteering History

Please list your most recent experience first.

Date / Job/Role / Responsibilities/Duties

Educationand Training

Please list most recent first

Date / School or Training Course / Qualification gained (if applicable)

Please explain briefly why you want to volunteer for Age UK:

Referees

Please give the names of two referees who have been known to you for more than two years. These should not be members of your immediate family. If possible at least one should have known you in a work related or professional capacity. If you are a student, a teacher or tutor would be an appropriate referee.

  1. Name:
/
  1. Name:

Address:
Postcode: / Address:
Postcode:
Telephone number: / Telephone number:
Email address: / Email address:
Relationship to you: / Relationship to you:

Criminal convictions

Age UKDroitwich Spa works with vulnerable clients and therefore has a duty to carry out checks with the Disclosure and Barring Service (DBS). Depending on the role you are applying for you may be required to undergo a DBS check.

Your information

Information on our database is strictly confidential and we do not pass on any personal data about you to outside organisations and/or individuals without your express personal consent.

In accordance with the Data Protection Act 1998, I agree that Age UK Droitwich Spa may hold and use personal information about me for volunteering reasons and to keep in touch with me. This information, including that contained in this application can be stored on both manual and computer files.

Statement

I understand that the information I have supplied will be treated in the strictest of confidence, and that it is accurate to the best of my knowledge.

I am willing to attend an interview and will accept the decision of Age UK Droitwich Spa.

Signed:Date:

Please return this form along with the Equality & Diversity Monitoring Form to:

Chief Executive,Age UKDroitwich Spa, Severn House, 32 Ombersley Street West, Droitwich Spa, WR9 8QZ.

Please mark the envelope ‘private and confidential’.

Z:\Level 2\Website & Social Media\Documents\Volunteer application form Dec 2016.doc