Volunteer Application Form – Confidential

Title

/ Mr/Mrs/Miss or Other

First Name

Surname

Date of Birth

Address
Post code
Email
Phone
Mobile
Occupational status
Access needs, e.g. induction loop, wheelchair access

Volunteer role

Please tell us what role you would like to volunteer for. You may tick more then one box. / Support Volunteer ☐
Outreach Service Volunteer ☐
Admin Support Volunteer ☐
Welfare Cheek volunteer ☐
Befriender ☐
Driver ☐Other ☐☐
Please tell us why you would like to volunteer with Connection Support
Do you have a full British driving licence? / YES / NO
Are you a driver, willing to use your own car for voluntary work? / YES/ NO
Have you previously had support from Connection Support Service? / YES/ NO
Do you speak any other languages or have experience with other cultures?
(please list)
Please list any skills/experience or attributes that you feel may be able to help you as a volunteer?
Do you have any hobbies or interest that you would like to tell us about?
Please give us an indication of your availability
Weekdays:
Weekends: / Times:
Times:

Under the Rehabilitation of Offenders Act 1974 and because you will be working with vulnerable people, you will be required to declare all criminal convictions including those which are spent.

Do you have any Criminal Convictions (other than minor dirving offences)?
A criminal record will not necessarily prevent you form volunteering with us. / YES/ NO
If you have answered yes, please give details of each convictions:
Please give details of two people who have known you for two years and will provide character reference
If relevant, you current or recent employer should be one. If you are unsure who to choose, please still apply and discuss this with us at interview.
How did you find out about us?

All volunteering will be subject to a satisfactory DBS police check & three month review.

I declare that the information I have give is true and correct. In signing this form, I give my consent to references being contacted as indicated. I understand that the informationsupplied is to be used for the purpose of volunteering with Connection Support and that DBS (Disclosure and Barring Service) will be carried out.

……………………………………………………………… ………………………………

Signed Date

Thank you for your interest and applying to volunteer with Connection.

Please return this form to;

Volunteer Coordinator

Calydon House

1 Edison Road

Aylesbury

HP19 8TE