Volunteer Application Form

1. Area of interest

Which area are you interested in? Activity Group Volunteer Gentle Exercise Class Leader Lunch Club Coordinator Home Visiting Befriender Telephone Befriender Retail Volunteer

Location - Where would you like to volunteer

2. Personal details

Title

Name

Date of Birth

Address

Postcode

Home telephone

Work telephone

Mobile phone

Email address

Car driver Yes No

Status

In order for us to offer you appropiate support in your volunteer role, please advise us of any health problems or medical conditions that you think may affect the type of volunteer duties that you can do.

3. Personal experience

Please outline any skills, interest, hobbies and previous experience

4. Your availability

When will you be able to start volunteering?

5. References

In both the interest of yourself and the people with whom you will be working, we require a reference from two referees who have known you for at least 2 years. These referees must not be family members.

If your circumstances mean that you are unable to provide current references, we will be happy to discuss this further with you.

Reference 1.

Name

Address

Postcode

Telephone number

Relationship to you

Reference 2.

Name

Address

Postcode

Telephone number

Relationship to you

6. Criminal convictions

As an agency working with vulnerable people, certain volunteer roles are considered exempt from the provisions of the Rehabilitation of Offenders Act 1974 and any convictions must be declared.

You must disclose all previous convictions; none of these may be considered spent.

Have you ever been convicted, warned, reprimanded or cautioned for a criminal offence, or liable in a civil case? Yes No

If yes, please outline the details of the offence below

We may require a criminal records check. (Only if visiting people in their own homes). Do you give your permission for us to carry out a check? Yes No

7. Emergency contact

Name

Address

Telephone number

Relationship to you

Has this person agreed to be your emergency contact? Yes No

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Volunteer Application Form

To volunteer at Age UK South Lakeland please complete the form below.

1. Area of interest

2. Personal details

3. Personal experience

4. Your availability

5. References

In both the interest of yourself and the people with whom you will be working, we require a reference from two referees who have known you for at least 2 years. These referees must not be family members.

Reference 1.

Reference 2.

6. Criminal convictions

As an agency working with vulnerable people, certain volunteer roles are considered exempt from the provisions of the Rehabilitation of Offenders Act 1974 and any convictions must be declared.

7. Emergency contact