Direct line: Barnet 0207 216 4449 Chase Farm 0208 375 1349

Email for Barnet: Beverley.smith28@nhs.net or louise.bellass@nhs.net

Email for Chase Farm: Beverley.smith28@nhs.net or
meeling.woo@nhs.net

Application form for Voluntary Placement

Title: Mr/Mrs/Miss/Ms/OtherMr.
Surname

Payandeh
Forename(s)
....Shoheb...
.
Address
219 Colney Hatch
Lane.
.
Postcode
N10 1AP Date of Birth
06/09/1998 (Must be 17 yrs +)
Telephone: Home 07855812240.. Mobile
07448503317
E-mail address:
jankabul@hotmail.co.uk..
Occupation:
student.
Are you currently?

Employed:
full time ( ) part time (
)
Student ( yes )
Unemployed ( ) Retired ( ) Other (
)

Country of Birth ....

Afghanistan.
Nationality British
Asian
Do you have right to work in the UK? Please circle: ( Yes ) ( N )
( Unsure)

Next of Kin: Javid Relationship to you:

father..
Address: same as
above
.
Telephone number: Home Mobile
07855812240
1.

Which hospital are you interested in volunteering at?

Barnet ( yes ) Chase Farm ( ) Other, please state which (
)

2.

Please tell us your reason(s) and or motive(s) for applying to be a

volunteer at the Barnet or Chase Farm Hospital?
I want this to look on my cv for university and I am interested in
medicine.

3.

What qualities, skills or experience do you have, that you could

use as volunteer to benefit the patients or the hospital?
I have confidence of doing mistake and correcting my self.

4. Have you volunteered anywhere before?

No I have not volunteered before.

5. How do you think volunteering differs to paid work?

Volunteer differs from paid work because you do it because you like doing
it.

6. Which volunteer role(s) are you interested in applying for?

Choose a maximum of four roles:
1.sat/nav guide
2.enquiries desk
3.xray
4. ward assisstance
7. What expectations do you have about volunteering at the Royal
Free?
I have expectation that I have to work very hard and try to learn a lot
of things.

8. Do you speak any other languages?

I can speak Urdu, Persian and pashto
9. Please tell us your views on equality and diversity in the
workplace?

I like to work with other people that are not only from my status
but work with everyone.

10. Would you be available to occasionally commit at short notice?

Yes I would be available to do any at short notice.
11. Are you sure that you are able to commit to the required 3-4 hours
per week for 6 months (minimum), to be worked within Mon Fri
9am to 4pm only? Please detail your availability;
No I have school

12. Please tell us, in your own words, why we should offer you a
voluntary
placement at Barnet or Chase Farm Hospital?

I would be very helpful with every patience and staff member.

References
Please provide the names and addresses of two people who you have
known for at least 12 months. They must be over 18 years of age and
not a member of your family.
If you are currently in education, employment, training or
volunteering, please provide a reference from there. (In this
instance, we understand that you may not have known them for
12months)
1) Name: .
Address: .
..
Post code: ..
Telephone: Home .
Mobile
E-mail address: ..
2) Name: ..
Address: ..
..
Post code: ..
Telephone: Home .

Mobile: ..
E-mail address: ..
Declaration
I certify that all the information given on this application form is true to the
best of my knowledge.
Signature: . Date:
Thank you for completing this application