As you will be working with vulnerable members of the community we require 
two references, one of which should be work related. Referees should not be related to you, or living with you as your partner, and should have known you for at least 2 years.  Please give full postal or email addresses
1st Referee
Name:		___________________________________________
Address:	___________________________________________
		___________________________________________	
Postcode:	___________________
Email:		________________________________________________
In what capacity do they know you?   _______________________________

2nd Referee:
Name:		___________________________________________
Address:	___________________________________________
		___________________________________________	
Postcode:	___________________
Email:		________________________________________________
In what capacity do they know you?   _______________________________

Data Protection: 
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.   

Project:  
Club:                                  Day:
Started:

Induction Training attended ……………………………………………	  ID Badge issued ...........................
 Handbook/ Policies/ SGA info issued   
  Confidentiality + Equal Opportunities statements signed and returned                                 

for official use

VOLUNTEER REGISTRATION FORM

Bradbury Centre, Stockton Road
Sunderland.  SR2 7AQ
T 0191 514 1131 F 0191 567 0378
E enquiries@ageuksunderland.org.uk
www.ageuksunderland.org.uk
CEO: Tracy Collins

Date form completed: _____________________   
Name:	______________________________________________________________
Address: _______________________________________________________________
	______________________________________________________________      
Postcode: _________________ 		DoB:  ___________________________________
Tel No: 	_________________________ 	mobile _____________________________
Email: __________________________________________________________________ 
Emergency contact person: parent/spouse/partner/other ....………………………..………
Name:	_______________________________	Tel: _______________________
Address (if different) _______________________________________________________
With which Age UK Sunderland services are you interested in volunteering? (Please tick)          Please Note: All posts are subject to a 6 - 8 week trial period
  Living Well Link		  Office work/Admin
  Advice + Information	  Day/Lunch Clubs	  Social Focus
  Advocacy  	    	  Dial-a-Driver		 I.T. (occasional)
  Befriending		  Essence Service

Please give details of any relevant experience/training/interests ______________________________________________
_________________________________________________________________________

Where did you hear about Age UK Sunderland (Please tick)
  Age UK Poster		    Friend	     Website          	  Volunteer Centre
  Church		      GP’s surgery	     Library	  Echo/local press	          
   other – please specify ___________________________________________________________________.

__________________________________________________________________________________________

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 relevant boxes below: 

Gender  (please tick)	  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 Criminal Records Bureau 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 DBS clearance.

Signed:

	Date:	
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?  If so what benefits do you think there are? ________________________________________________________

________________________________________________________________________
________________________________________________________________________

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 and times when you would be available.  ___________________________________

________________________________________________________________________

We cover all areas in the City of Sunderland including Hetton, Houghton, and Washington.   Do you prefer your locality or are you prepared to travel?  __________________________

________________________________________________________________________

Are there any health issues relating to you of which we should be made aware? 
(e.g. allergies/asthma) _________________________________________________________________
______________________________________________________________________________________
_______________________________________________________________________________________