Volunteer Application Form

Step 1: Your personal details

Title -- Select an option -- Miss Mrs Ms Mr Dr Other

First Name *

Surname *

Full Postal Address *

Postcode *

Date of Birth *

Gender

Male Female Other Non-Binary Prefer not to say

Your Contact Details

Main contact number *

Email Address *

What type of work would you like to do for Age UK Merton?

Please select which services apply:

Face-to-face befriending (Role available 7 days-a-week) Telephone befriending (1 call a week) Handyperson Activity centre walk leader Admin support Activity Leaders & Assistants Information & Advice Assistants Outings Leaders & Assistants Ad Hoc Promotion & Events Fundraising Collection Lunchtime Support Reception

About Yourself

What type of paid work have you done? *

Have you done any voluntary work before? If so, state where, what sort of responsibilities; how long for; and what type *

What could you bring to Age UK Merton? *

Your availability

Tick availability

Monday AM Monday PM Monday after 5pm Tuesday AM Tuesday PM Tuesday After 5pm Wednesday AM Wednesday PM Wednesday after 5pm Thursday AM Thursday PM Thursday after 5pm Friday AM Friday PM Friday after 5pm Saturday AM Saturday PM Saturday after 5pm Sunday AM Sunday PM Sunday after 5pm

Where did you hear about volunteering with us?

Tick all that apply

Word of mouth Age UK national website Local library Do It. website Age UK Merton volunteer/staff Other volunteer centre Newspaper/article Social Media post Age UK Merton website Voluntary organisation Other

If other, please specify *

Consent

Do you consent to us keeping your basic details on our database for monitoring purposes? Your details will be kept confidential and not passed onto a third party.

Yes No

Would you like to receive updates, information and marketing emails

Yes No

Criminal offences and DBS check

Have you ever been convicted of a crime, including all unspent convictions? If yes, please provide details as Age UK Merton will need to assess if you are able to volunteer with us. A disclosure does not necessarily exclude you from volunteering with us. The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are 'protected' and are not subject to disclosure and cannot be taken into account. Guidance and criteria on the filtering of these cautions and convictions can be found on the Disclosure and Barring Service website

Yes No

Some volunteer roles require a Disclosure & Barring Services (DBS) check. Do you consent for Age UK Merton to carry out this check?

Yes No

References

Name *

Address *

Postcode *

Email *

Telephone number *

How are they known to you? *

Can we contact them prior to your interview? *

Referee 2

Name *

Address *

Postcode *

Email *

Telephone number *

How are they known to you? *

Can we contact them prior to your interview? *

Equal opportunities

Ethnic background (tick as applicable)

White British White Irish White European White (Other) Black British Black African Black Caribbean Black Other Asian British Asian Bangladeshi Asian Chinese Asian Indian Asian Pakistani Asian Tamil Asian Other Mixed White and Asian Mixed White and African Mixed White and Caribbean Mixed Other backgrounds Other ethnic background (please specify) Do not wish to disclose

Other ethnic background *

Declaration

I declare that the information and details furnished in this application form are true and correct to the best of my knowledge and belief, and I will not willfully suppressed any material fact

I agree I disagree

Full name *

Date *

*

Submit