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Your Details

Title (Ms/Mr/Dr etc) *:

First Name *:

Surname *:

Address Line 1 *:

Address Line 2:

Town *:

Postcode *:

Telephone *:

Mobile *:

Email Address *:

Date of Birth *:

Gender *:
MaleFemaleTransgenderOther

If "Other" please give more details:

Ethnicity (e.g White British) *:

Do you consider yourself to have a disability? *:
YesNo

If "Yes" please give more details:

Blue Badge Holder:
YesNo
Religion or Belief *:
No ReligionFaith

If "Faith" please state which:

Relationship Status *:
SingleMarriedCivil PartnershipCohabitingWidowedDivorcedOther

If "Other" please give more details:

Sexuality *:
HeterosexualLesbianGayBisexualOther

If "Other" please give more details:

Employment Status *:
RetiredEmployedUnemployedOther

If "Other" please give more details:

Present employment or voluntary work:

(Please provide details of current employment or volunteer work e.g. job title, name of organisation and dates employed/volunteered if applicable)

How did you hear about the vacancy? *:

(E.g. internet, word of mouth, local advert, radio etc)

Please state which voluntary role(s) you are you interested in? *:
Transport DriverHome Support/Group SupportFundraising

Transport

Do you have use of a car for voluntary work? *:
YesNo
Do you have a current, clean driving licence? *:
YesNo

Availability

Please indicate when you are most likely able to volunteer:

Mornings
MonTueWedThuFri
Afternoons
MonTueWedThuFri

Application

Please indicate any personal experience of cancer or other life limiting illness?

Have you had a major personal loss within the last 2 years?

(e.g. Redundancy, bereavement, divorce, major illness etc)

Please indicate why are you interested in helping people with cancer or other life-limiting illness?

Please provide information of any qualifications, recent training and/or experience that is relevant to volunteering with Being There

Please provide information of any hobbies and interests

Your Referees

Because of the confidential nature of the work it will be necessary for us to take up references. Please give details of two people (NOT RELATIVES) who have known you for at least two years, preferably in connection with some work (either paid or voluntary) to whom we may apply for references. Submitting this form will be treated as consent to these enquiries being made.

Reference 1

Forename:

Surname:

Address Line 1:

Address Line 2:

Town:

Postcode:

Telephone:

Mobile:

Email Address:

Job Title (if applicable):

Company (if applicable):

Reference 2

Forename:

Surname:

Address Line 1:

Address Line 2:

Town:

Postcode:

Telephone:

Mobile:

Email Address:

Job Title (if applicable):

Company (if applicable):

Emergency Contact Details

Full Name *:

Telephone *:

Mobile *:

Email Address *:

Relationship to you *:

Declaration

I confirm that the information on this form is true and correct
I agree to abide by the volunteer policies/procedures of Being There

In accordance with the Data Protection Act 1998 I give permission for this personal information to be stored and processed for the purposes of volunteering and monitoring and for sensitive data to be stored and processed in connection with equal opportunities, health and safety reasons and compliance with the requirements of national standards.

Declaration of Criminal Record

As an organisation committed to equality and diversity, Being There recognise the contribution that all people can make as volunteers and so we welcome enquiries of interest from everyone. We recognise too that some potential volunteers have criminal records and are reluctant to apply for voluntary work where this would involve the disclosure of their record. We understand that people are often may fear they will not be treated fairly because of them.

Please rest assured that we will handle any information provided below in confidence. Should you disclose them, we will not take into account convictions deemed spent under the Rehabilitation of Offenders Act, unless the voluntary position is exempt from the Act.

Some of our volunteer positions are exempt from the Rehabilitation of Offenders Act. As such, we will ask for disclosure of both spent and unspent convictions, and also cautions, reprimands, and final warnings. Where appropriate to the role, we will also ask you to agree to a Disclosure and Barring Service check. If the DBS check reveals information that we were not previously aware of, we will discuss the matter with you before making a final decision. Whilst it is unlikely that a Criminal Record would prevent you from volunteering, we consider each case on an individual basis.
Have you ever been convicted by the courts or cautioned, reprimanded or given a final warning by the police? *
YesNo
If yes, please give details of offences, penalties and dates:

Are you aware of any police enquires undertaken following allegations made against you, which may have a bearing on your suitability for this post? *
YesNo
If yes, please give details:

I consent to my data being stored in line with the Privacy Notice

* indicates required field