Name
Address
Postcode
Date of Birth
Home telephone number
Mobile number
Email address
NoK/emergency contact person: parent spouse/partner other
Name: / Tel:
Address:
Please click on the Age UK Sunderland services in which you are interested Please note: all posts are subject to a 6 – 8 week trial period
ActivAge / Charity Shop / Office work/Admin
Advice and Information / Day/Lunch Clubs / Social Focus
Advocacy / Dial-a-Driver / Sustainable Homes
Area Offices / Friendly Faces / Telephone Service
Please give any details of any relevant experience/training/interest:
Please indicate where you heard about Age UK Sunderland (please click on relevant box)
Age UK Poster / GP’s surgery / Echo/local press
Church / Library / Volunteer centre
Friend / Website
other – please specify:
As you will be working with vulnerable members of the community, we require two references. The referees should not be related to you, or living with you as your partner, and should have known you for at least two years.
1st referee / 2nd referee
Name
Address
Postcode
Capacity in which they know you
Please state the days and times you have available for volunteering:
I confirm the information I have given to Age UK Sunderland is correct. I agree that Age UK Sunderland may process that information. I understand that Age UK Sunderland operates in accordance with the principles of the Data Protection Act, 1998 and that the information given will be used by Age UK Sunderland and its trading subsidiary Age UK Sunderland Services Limited.
I understand that information will only be shared with third parties and partner organisations when necessary to provide a relevant service.
I confirm my agreement to this statement.
If you do not wish to receive information about products and services provided by Age UK Sunderland please tick this box.
Why do you want to volunteer with Age UK Sunderland? (e.g. work experience, retirement, bereavement, stayed after placement)
What experience do you have of working in a team environment?
What experience do you have of working as an individual?
As a volunteer for Age UK Sunderland you will be responsible for assisting in the care of older people. If a person became poorly while in your care what action would you take?
What are the biggest issues facing older people in today’s society?
How much time do you have available to volunteer for Age UK Sunderland? Please state days andtimes you would be available
We cover all areas of the City of Sunderland including Hetton, Houghton and Washington. Do you prefer to volunteer in your locality or are you prepared to travel?
Are there any health issues relating to yourself of which we should be made aware? (e.g. allergies/asthma, etc.)
EQUALITY AND DIVERSITY
Age UK Sunderland is committed to the principle of equal opportunity in employment for all its employees, volunteers and applicants for employment, regardless of their age, race, gender, marital status, sexual orientation, religious belief, ethnic origin, nationality, national origin or disability.
We are committed to developing positive policies to promote equal opportunities in employment and prohibiting unlawful or unfair discrimination in the workplace.
At the induction training you will be required to complete our Equal Opportunities monitoring form, but please complete the relevant boxes below:
Gender (please click on relevant box)Male Female
Nationality: Country of birth:
with a disability (e.g. need wheelchair access ) without a disability
Criminal Convictions
Due to working with vulnerable adults, your role may be subject to Disclosure and Barring Service checks. A conviction does not necessarily mean you will not be considered. Each case is considered on its merits. This role is exempt from the Rehabilitation of offenders Act 1974, so applicants are not entitled to withhold any criminal information including those considered spent
Have you ever been convicted of a criminal offence, or received a caution, reprimand, or warning? No Yes
If YES, details are required with this application form (on a separate sheet); they will not necessarily debar you from volunteering with Age UK Sunderland.
DECLARATION: I confirm that the information I have provided is correct to the best of my knowledge and that I have not omitted any relevant details. I understand that the information given about me will be held manually, and on computer, and that this information may be used for administrative purposes including analysis for management and statutory returns. I am aware that the appointment as a volunteer will be subject to satisfactory references and possibly CRB clearance.
Signed:Date: