VOLUNTEER APPLICATION FORM

Please note: To become a young volunteer you must be aged 16 Years or above
PLEASE PRINT
Name in full:(Mr/Mrs/Miss/other)
...............................................................
Address
...
Postcode..
How long at address if less than 5 years.
Home Telephone Number
Mobile Number.
Email address (if regularly used)
Date of birth

--/--/----

(DD/MM/YYYY)

Name & telephone number of person to contact in an emergency

What relationship are they to you? .

You will have to have a medical but are you in good health ? YES/NO

If no please indicate any disabilities or health problems which may require special arrangements

How did you find out about becoming a volunteer? Website, word of mouth etc.

Application Form Shared 2015

Please give the name and address of two referees. These should be people who have
known you for at least 2 years. They must not be related to you, e.g. your Brother, Aunt or
Sister-in-law, but should be someone who can tell us about you as a person e.g. your
tutor, your neighbour, your sports coach or your current or previous employer:
1.

Name

Address
..........................................
Email address.
How long have they known you, and in what capacity.........................................................................
..............................................................................................................................................................

2.

Name

Address
..........................................
.
Email address.
How long have they known you, and in what capacity
DISCLOSURE & BARRING SERVICE CHECK
As a Trust who is committed to securing the safety of its patients, volunteers
staff and property, we use the Disclosure & Barring service. This will be at an
enhanced level. With one of our values being HONESTY we encourage
applicants to tell us about convictions, cautions, reprimands and warnings
during the application and interview process, regardless of when they took
place. Having a criminal record may not necessarily bar you from volunteering
with us; this will depend on the nature and circumstances of your offences.
Do you have any convictions, cautions reprimands Or final warnings
which would not be filtered in line with Current guidance?
YES

NO

(Tick as appropriate)

(If YES, please provide details on a separate sheet of paper)

VOLUNTEERS DECLARATION
I confirm that the information that I have provided in this application form is
correct and complete. I understand and accept that if I knowingly withhold
information, or provide false or misleading information, this may result in my
application being rejected or my placement being terminated
Signature.. ..
Application Form Shared 2015

Date...

______________________________________________________________________________

Please return completed application form to:

Louise Beedle & Rachael Pearce 1st Floor Alderson House, Anlaby Road, HULL HU3 2JZ
Telephone:- 674326 / 675189

VOLUNTEER APPLICATION : SUPPORTING INFORMATION

NAME .
ADDRESS .
From the role profile issues with your application form please state, in
200 words, why you would like to join us as a volunteer.
Please include the following:
What you hope to gain by becoming a volunteer
What your future aspirations are
How you feel volunteering will help you to achieve these
How you have demonstrated your commitment to
something
.

Application Form Shared 2015

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Application Form Shared 2015

Application Form Shared 2015