Volunteer Application Form

Phone

This field is for validation purposes and should be left unchanged.

About You

Your Name(Required)

First Last

Your Address

Street Address Address Line 2 City Post Code

How Can We Reach You?

We would love to chat with you. How can we get in touch?

Preferred Method of Contact

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

Best Time to Call You(Required)

Which roles would you like to volunteer for?

Please tick all appropriate roles

Volunteer Role(Required)

Employment Status (required)(Required)

Full or part time education

Full or part time employed/self employed

Unemployed

Retired

Date of Birth(Required)

We will need proof of ID later on in the process

Gender

What is your availability for this role?(Required)

What motivates you to volunteer with us(Required)

Gain new skills, knowledge and experience

Contribute and give back to the local community

I have personal experience of being supported by St Raphael’s Hospice

Feel valued and part of a team

Use professional skills and knowledge to benefit others

Gain confidence and self-esteem

Other

If you have any skills, experience or knowledge that relates to the role, or any other skills that would be useful please let us know.

Additional Information

Do you consider yourself to have a disability?(Required)

If you have ticked yes to the question above please select one of the below. The information given will be completely confidential and only considered in relation to your request to be a volunteer.

All people have different needs and requirements; therefore, we ask you to share with us anything about yourself that will enable us to give you maximum support. This might include health conditions or allergies

An additional Health Assessment maybe required. Are you happy to receive the details by email?(Required)

Under the Rehabilitation of Offenders Act 1974, do you have any spent or unspent criminal convictions?(Required)

Do you hold a full clean driving license?(Required)

References

Please provide addresses of two referees you have known for at least 6 months who are not family members.

Referee 1

Name(Required)

Relationship to you(Required)

Phone Number(Required)

Email address(Required)

Referee 2

Name(Required)

Relationship to you(Required)

Phone Number(Required)

Email address(Required)

Emergency Contact

Please provide details of someone we can contact in case of emergency. These details will be used for this reason only.

Name(Required)

Relationship to you(Required)

Phone Number(Required)

Email address(Required)

Consent

General Data Protection Regulation 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.

I give consent for St Raphael’s Hospice to contact me in the future via newsletters and updates regarding the charities work, other volunteering opportunities, events and fundraising?(Required)

Yes

I hereby confirm that the above details are correct to the best of my knowledge and I have read and understand that my details will be stored by St Raphael’s Hospice.(Required)

Yes

How did you hear about this volunteer opportunity?(Required)

If you selected other, please give details