Volunteer Application Form

Broken Rainbow LGBT Domestic Violence Service (UK) is registered in England and Wales, Company Limited by Guarantee. Company Number 5009850. Broken Rainbow UK, PO Box 68947, London, E1W 9JJ. Charity Number: 1103624.

WHO WE ARE

Broken Rainbow is the first and only UK organisation dedicated to confronting and eliminating domestic violence and abuse within and against the LGBT communities. We formed in 2002 and became a registered charity in 2004.

Mission

LGBT communities have changed radically. Within the last ten years, new legislation has given LGBT communities rights and equalities that we could not have imagined only a few decades ago. We have become confident and bold, challenging oppression and able to make demands. However, we are only just beginning to acknowledge the presence of domestic abuse and domestic violence within our community.

Broken Rainbow UK is dedicated to bringing the issue out into the open, raising awareness, and offering help and support to those whose lives have been affected by domestic violence or domestic abuse.

Our expertise and experience means we are uniquely placed to offer support and targeted services to LGBT people experiencing domestic violence and abuse in the UK.

Objective

Our objective is to relieve the distress and suffering caused to lesbians, gay men, bisexual and transgender people by domestic violence and abuse, in particular but not exclusively by doing the following:

Raising awareness in the LGBT communities and elsewhere of the impact of homophobic, transphobic, biphobic and same sex domestic violence and abuse on the lives of LGBT people;

Offering advice, support and referral services to LGBT people experiencing homophobic, transphobic, biphobic and same sex domestic violence and abuse;

Offering information, advice and training to people who are responsible for domestic violence policy and practice in mainstream and specialist organisations, or who are otherwise involved with the survivors and perpetrators of those suffering from domestic violence or abuse, with a view to increasing the physical safety and mental well-being of LGBT people who experience such violence or abuse.

Office use only
Date received

Please complete the information below, which will be treated with confidence

Contact details
Title / First name / Surname
Address
Postcode
Tel. (day) / Tel. (eve) / Tel. (mobile)
Email address
Volunteer Information
Role applied for (if any) / ONLINE CHAT VOLUNTEER
Please list some of the skills, knowledge or abilities you feel you could bring to our organisation / · 
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Tell us how many hours a month you would like to give
Online chat volunteers are asked to do four hour shifts
Which days/evenings are you available?
How did you find out about us?
Name and contact details of two references.
(One of which should ideally be a recent employer/volunteer coordinator) / If you are unsure who to include, please still complete the rest of the form and we can discuss this with you.
Rehabilitation of Offenders Act (1974)
Recruitment of Ex-Offenders – Some of our volunteering opportunities may involve direct contact with potentially vulnerable people. As such, applications to volunteer are exempt from the Rehabilitation of Offenders Act 1974.
This means that potential volunteers are required to declare their entire criminal record, including cautions, reprimands, final warnings and criminal convictions categorised s `spend’ under the above legislation.
Please complete and sign this section. The information provided will be kept confidential.
It will only be disclosed to specific Broken Rainbow staff if/when they are considering you for specific volunteering opportunities (where you may come into contact with potentially vulnerable people).
Some of our volunteer roles are subject to an enhanced DBS check.
Do you have any ‘spent’ convictions? / Yes / No
Do you have any ‘unspent’ convictions? / Yes / No
If Yes, please give details, including date(s) and nature of offence(s).
I declare the information contained in this form is correct.
Full Name
Date

If you have any difficultly completing this form, please email: help@brokenrainbow.org.uk