UCH Macmillan Cancer Centre volunteering application form

Contact Details

Title

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First name

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Last name

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Address

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London

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Postcode

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Telephone (home)

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Telephone (work)

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Mobile

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Email

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In an emergency who would you like us to contact?

Name

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Relationship

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Contact number

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Please tell us which volunteer role(s) you are applying for

Work experience over the past 5 years whether paid or unpaid (please continue on separate sheet if necessary)

Date from / Date to / Organisation name / Position held / Main responsibilities

Relevant training and qualifications (please continue on a separate sheet if necessary)

Dates / Where Trained / Qualification Gained

Please tell us more about your skills and experience

Please tell us why you want to volunteer at the UCH Macmillan Cancer Centre, outlining how your skills and experience fit the role description and any relevant abilities or languages that you have. You can continue on a separate sheet and enclose/ attach a CV if you wish to do so.

How much time can you offer?

Please check the role description for the days and times we need volunteers and highlight when you are available on a regular basis below.

Monday

Morning
Afternoon / Tuesday
Morning
Afternoon / Wednesday
Morning
Afternoon / Thursday
Morning
Afternoon / Friday
Morning
Afternoon / Saturday / Sunday

Is there anything we need to know about your health?

If you require additional support or equipment, please tell us so that we can try to meet your requirements.

How did you hear about volunteering at the UCH Macmillan Cancer Centre?

References

Please provide the names of two referees who can comment on your experience and your suitability to volunteer with the UCH Macmillan Cancer Centre. Ideally these should be people you have worked with (either as a volunteer or as an employee) and neither should be a relative.

Referee 1

Referee 2

UCH Macmillan Cancer Centre

Volunteer Application – Declaration Form

Applicant’s Name: ______

DECLARATION OF CONFIDENTIALITY

I agree that any personal information concerning patients (including details of their condition, diagnosis, treatment, address etc) which may become known to me during my volunteer work at the UCH Macmillan Cancer Centre will be treated by me with the strictest confidence, and will not be passed on to any other unauthorised person, or discussed in a public place.

I understand that if I breach this agreement I may be dismissed immediately.

Signed: ______Date: ___

Thank you very much for your interest in volunteering at the UCH Macmillan Cancer Centre.

Please return the completed application form to: post your form to: Naomi Neiland, Volunteering Manager, UCH Macmillan Cancer Centre, Huntley Street, WC1E 6AG