Volunteer mentor/volunteer application form

Please answer all questions using BLOCK CAPITALS.

We do not accept CVs, please complete the application form.

Personal details / Race / ethnicity
Title / Please mark X in the box relevant to you
First name / White
Surname / British
Irish
Other (specify):
Sex / M / F / Black or Black British
Proof of right to work in the UK
(please state proof) / Caribbean
Home address / African
Other (specify):
Mixed
White and Black Caribbean
White and Black African
Home e-mail / White and Asian
Work e-mail / Other (specify):
Home telephone* / Asian or Asian British
Work telephone* / Indian
Mobile* / Pakistani
*please indicate best time / method to contact you / Bangladeshi
Chinese
Other Ethnicity
Specify:
General
Why would you like to become a volunteer mentor?
What experience, if any, do you have with children and or young people?
What recreational interests, e.g. hobbies, sports, do you have that you could share with a young person?
What languages do you speak?
How did you first learn about E-Spired? (tick all that apply, detailed information is very helpful for us)
Internet Which search engine or website? ______Friend/Family A former mentor
Twitter/FacebookWhich @/Fb address? ______Newspaper Which one? ______
Volunteer BureauWhich one?______Poster/postcard Where?______
Work/University/College Which one?______Other (please specify): ______
Emergency contact details / Health
Title / Do you have any health problems or a disability that you feel might affect your work with E-Spired? If yes, give details.
First name
Surname
Relationship to you
Home address
E-mail
Home telephone
Work telephone
Mobile
Employment history
What is your current status?

Full-time employed Part time employed Unemployed Retired Student
Other (please specify)
Please give details of your current job and any other relevant work history. Use a continuation sheet if necessary.
From / To / Job title / Organisation / Describe your work
Please give details of any voluntary or charitable work you have done, starting with the most recent.
Use a continuation sheet if necessary.
From / To / Job title / Organisation / Describe your work
References
Please give details of at least two referees who have known you in a professional capacity for six months or longer. One must be your current/most recent employer – ideally your Manager or other senior colleague - or a recent academic reference. None of your referees can be family or friends. We will write to your referees once you are invited to interview.
Name / Occupation
Relationship to you / Length of relationship
Address
E-mail / Telephone
Name / Occupation
Relationship to you / Length of relationship
Address
E-mail / Telephone
Name / Occupation
Relationship to you / Length of relationship
Address
E-mail / Telephone
Disclosure
All volunteer applicants must complete an enhanced disclosure records check, to ensure the safety of the children and young people with whom we work. These checks are strictly confidential to registered E-Spired staff. Please note, not all criminal convictions automatically preclude applicants from working with E-Spired; however, if you have any listed convictions or cautions we may contact you to clarify matters before processing your application. Please contact if you would like to speak to someone about this.
Are you subscribed to the DBS update service? Yes No

If yes, do you give consent for E-Spired Yes No
to do an online status check?
Have you ever been convicted of a criminal offence?
Yes No
If yes, please give full details: / Have you been the subject of an allegation or disciplinary action in relation to working with children?
Yes No
If yes, please give full details and date:
Declaration
I declare that the information on this form has been supplied by me and is correct.
Signed: Date:
Please return your completed volunteer mentor application form to:

For office use only
Name of volunteer
Sent / Received / Checked
Ref 1
Ref 2
Ref 3
DBS check
DBS check (resent)
Passed Yes No
Date / Interviewer1 / Interviewer 2 / Accepted? / Notified
Interview 1 / / Yes No
Interview 2 / / Yes No
Notes
E-Spired CIC
Unit C, Bedford Business Centre
Mile Road
Bedford, MK42 9TW
Telephone: 01234 323 4000
E-mail:
Website: www.espired.org
E-Spired CIC, Company No: 09846850