Hospice Volunteer Application Form

Your Details
Next of Kin Details (emergency use only)
Your Availability
Your References

Please provide below the names and contact details of two people we could contact for a reference (must not be a family member).

Referee 1

Referee 2

Rehabilitation of offenders Act 1974 (Exemptions) Order 1975 and Health Clearance

As a Volunteer in the Hospice you may be in a patient-facing role working with Vulnerable Adults. If so, your appointment will be subject to a satisfactory check from the Disclosure Barring Service (DBS). The position would be exempt from Section 4 (2) of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. This means that you are not entitled to withhold information relating to any convictions you may have had, even those which in other circumstances could be considered as “spent”. Any information should be supplied on a separate sheet attached to the application form. It will be treated as confidential and will not necessarily prejudice your application. You are also required to get health clearance from our Occupational Health Nurse before appointment to a volunteer role (a form will be supplied).

General Data Protection Regulations

In submitting this form, you acknowledge that you understand that your personal details will be held on a Database and in paper form. Access to your Personal Details is restricted to those who need it and will be passed on only with your consent. All records are handled in accordance with good practice compliant with the GDPR