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Application form

1. Please fill in the following information:
First Name:
Last Name:
Title:
Street Address:
Address (cont.):
City:
County:
Postal Code:
Day Time Phone:
Evening Phone:
FAX:
E-mail:
2. Are there any particular schemes you'd like to volunteer for? If so which ones are you interested in?
Volunteering for:
Have you ever done any voluntary work before? If yes, please give details
Voluntary work done before:
3. Do you have any experience of working with children, young people, physically/mentally disabled, elderly etc, either paid or unpaid? If yes, please give details
Particular experience:
4. Do you have any skills/hobbies or experience e.g. office work, music, craft-work, caring, committee work, sport, gardening, D.I.Y., technical, driving etc. which you would like to use as a volunteer? If yes, please give details
Skills/hobbies:
5. Employment Status: Choose one of the following options
Employment Status:
If Other, please state::
7. Benefits you are in receipt of: Select any of the following options that apply
Benefits:	Income Support Job Seekers Allowance Invalidity Benefit Invalid Care Allowance Sickness Benefit Other
8. If Other, please state:
Your rights to benefit may not be affected if you do Voluntary Work. You should get advice from the Bureau Manager.
9. When could you be available for voluntary work? Please state times
Available on::	Monday Tuesday Wednesday Thursday Friday Weekends
10. What sort of involvement would you like?
Type of involvement:	One-to-one Group Mobile One place
11. What type of people would you like to work with?
Type of people:	Old Children/Youth Physical Disability Mental Disability
12. What type of Voluntary work could you do?
Type of voluntary work:	Clerical work Help with Fund Raising Driving Help with activities Shopping Visiting
13. We need the following information for insurance purposes: Do you have any health problems that might affect your role as a volunteer? If Yes, please give details
Health problems:
14. Are you over 75?:	Yes No
15. Are you under 14?:	Yes No

Date: Sun, 5 Feb 2012. » Text Version. »

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