Fields marked • are required.

Application to Volunteer

GENERAL INFORMATION • Position applied for: • Name: • Date of Birth: National Insurance Number: • Address: Email Address: Telephone Number: Mobile Number: Do you hold a current driving licence? Where did you learn about this post? QUALIFICATIONS • Qualifications - School, College, training and In-house training (including grade and year): CURRENT VOLUNTEERING / EMPLOYMENT: Current position: Salary (if applicable): Commencement date: Period of notice required: Employment History
(Including name and address of employer, position held, from and to date):
PREVIOUS VOLUNTEERING / EMPLOYMENT:
Please list below what you feel is relevant.
• Information in support of your application
(give an account of any experiences which will support your application): If you have a disability please tell us below about any adjustments we may need to make to assist you at the interview/chat. REFERENCES FIRST REFERENCE Name: Position: Address: Telephone: Email: SECOND REFERENCE Name: Position: Address: Telephone: Email: Can we contact your references prior to interview? REHABILITATION OF OFFENDERS ACT 1974 Have you ever been convicted of a criminal offence? If 'yes', please provide details with dates: I confirm that the information I have given on this form is correct and complete, and that misleading statements may be sufficient for cancelling any agreements made. I understand that, in the event of being shortlisted for interview, I will be required to complete a confidential declaration in respect of the state of my health; because of the sensitive nature of the duties the post holder will be expected to undertake. I also understand that the declaration will include details of any criminal convictions, cautions, reprimands and final warnings and other information that may have a bearing on my suitability for the post. I understand too that a Data Barring Service Check in line with The Police Act of 1997 will be required for a successful application. Tick to agree to the above: Name: Today's date:

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