Volunteer Recovery Worker Application From

Volunteer Recovery Worker Application from

This form is confidentially treated throughout your application process

Please complete in full, use electronic typescript or black ink when completing this application.

Please DO NOT submit a CV as an alternative to any part of the form.

Inclusion Hampshire Volunteer Recovery Worker Scheme
Role Title(please refer to role description) / Volunteer Recovery Worker - Hampshire
Application Date:
Locality placement: Pleasestatewhich hub(s) you would consider volunteering at
How did you hear about Inclusion’s volunteer scheme?
Part A – About you
Your Surname / Initials
Home Address & Postcode
Telephone Numbers / Home: Work:
Mobile:
Email address
Please confirm that you are over 18 years old when making this application Yes  No 
I hold a full current driving licence? Yes  No 
I have access to a motor vehicle Yes  No 
I use Public transport only Yes  No 
Part B – My Circumstance
Please Circle your employment status: Full time, Part time, Unemployed, student, Retired, Other
If currently employed / studying, what hours or days are you already committed to:
If unemployed, retired or other please provide some details:
If you are applying for Secondment / Internship Please specify your circumstance:
Are you, or have you ever been a Recovery Supporter or Recovery Mentor? / Yes [ ] No [ ]
Have you ever had a concern with your own drug or alcohol use? / Yes [ ] No [ ]
Are you currently receiving treatment for drug or alcohol dependency or misuse any where? (this does not include AA,NA,CA) / Yes [ ] No [ ]
Do you have any concerns with your mental health or emotional wellbeing? / Yes [ ] No [ ]
Do you consider yourself to have any form of disability? / Yes [ ] No [ ]
Please use this space for any additional information to the above if required.
Part C – Your Educational / Vocational qualifications
Please tick your current ITC / Computer or data skill set
None [ ] Poor [ ] limited [ ] acceptable [ ] competent [ ] experienced [ ] very competent [ ]

Please list relevant qualifications obtained with their grades (include current studies if any)

Name of School/College/University or Professional Body / Subject / Qualifications Obtained
e.g. CSE, GCSE, A level, Higher Ed, Certificate etc / Grade
Part D – Personal specification responses
Give careful thought to any previous experiences and responsibilities that you may relate to the 8 variousperson specification requirements (A). EACH single response shouldn’t exceed 150 words. You may write up to 1200 words in total. You may continue on separate pages as necessary. The detailed answers you provide will make up to 75% of your short-listing score. Thank you.
Response 1
Response 2
Response 3
Response 4
Response 5
Response 6
Response 7
Response 8 (previous specific skills)
Part E – References
Please give the name and address of two referees. Ideally one should be your present or most recent employer. If school/college leaver, give the Head Teacher/Tutor etc. If you have not been employed, or have been out of employment for a period of time, you may wish to give the name of anyone who knows you sufficiently well to confirm the information that you have given, and to comment on your ability to volunteer for Inclusion. Partnership candidates should give the name of their current Line Manager as one referee. Your References needed to have hadregular contact with you in the past 12 months.References from Family members or close friends, and those from outside of the UK should be avoided.

Title & Name:

Occupation:

Email:

Tel No:

Inclusion will not contact referees without your permission, and never before interview stage. All information MUST be providedor your reference will be invalidated.

Part F – Rehabilitation of Offenders Act 1974
The post for which you are applying is exempt from the provisions of the above Act. Youare therefore not entitled to withhold any information about convictions you may have had including any “spent” convictions. Any information you do disclose will be kept in strict confidence and will be used only in consideration for your suitability for the post for which you are applying. In the event of appointment, any failure to disclose convictions willresult in immediate dismissal.
You must also disclose if you are currently subject to any kind of probation or supervision order.
Do you have anything to disclose? Yes [ ] No [ ]
I have unspent convictions Yes [ ] No [ ]
I am currently on Police bail Yes [ ] No [ ]
I am currently on a Probation or Home Office Licence Yes [ ] No [ ]
If you have ticked yes, please REQUEST a SSSFT Declaration form A. full details of the offence and outcomes will be required with your application, upon shot listing. Thankyou

Please return completed application by

Email to

or return to the Ringwood hub, Oaktree House, Ringwood, BH24 1DN for the attention of: Louise Hansford Volunteer Coordinator in an envelope marked ‘private and confidential’

If you need any further information at this stage please contact Louise Hansford either by email or by telephone on 07966899327

Thank you

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