Title:
First Name:
Last Name:
Address:
Town / County:
Postcode:
Date of Birth:
Home Telephone no:
Mobile Phone no:
Email:
How did you hear about Community Transport?
Please give details of any skills or interests you have, or any previous volunteering experience and why you wish to volunteer.
VOLUNTEER EMERGENCY CONTACT DETAILS - In the event of an emergency please contact the following:
Full Name:
Home Telephone Number:
Work Telephone Number:
Mobile Number:
Relationship to you:
Please supply any further information you feel might be helpful in the event of an emergency e.g. Regular medication taken, neighbours/key holders for your home. Should your personal circumstances change please notify us to ensure records are up to date at all times.
Do you have any medical conditions which might affect the kind of volunteering you can do? If so please give details, or discuss this with your volunteer manager
I declare that the information given on this form is to the best of my knowledge and belief true and complete.
Signed:
Date:
Declaration of criminal convictions. The Rehabilitation of Offenders Act 1974 (ROA) ensures that ex-offenders who have not re-offended for a period of time since the date of their conviction are not discriminated against when applying for jobs. The ROA enables ex-offenders to ‘wipe the slate clean’ of their criminal records in the sense that they are no longer legally required to disclose to an organisation convictions that are ‘spent’, unless the role they are applying for is exempted from the Act. Any declaration you make will be kept confidential as part of the recruitment process and each case will be decided on its own merits (Note some people are banned from working with children under the Protection of Children Act 1999 & Criminal Justice and Court Services Act 2000). When looking at declarations the recruitment panel will consider: • Whether the information revealed is relevant to the position • The seriousness of the offence(s) • The length of time since the offence(s) • Whether this was part of a pattern of offending or a one-off incident • The age of the applicant at the time and circumstances of the offence and explanation(s) of the applicant. Please be as honest as possible at this stage as an Enhanced DBS Disclosure may be requested prior to confirmation of appointment and your appointment will be subject to this being received and satisfactory as part of your recruitment. If you are unsure whether you need to declare something please contact the NACRO Resettlement Plus Helpline on 0207 8406464.
Have you ever been convicted of any criminal offence/s or received a caution or bind over? YesNo
I certify that the information given on this form is correct to the best of my knowledge. I agree to Community Action Partnership holding the information supplied subject to the Data Protection Act 1998. I also consent to Community Action Partnership obtaining a full (DBS check) where required.
Full Name (Block Capitals):
FURTHER INFORMATION - If you have a disability do you require any reasonable adjustments to be made to fully enable you undertake your volunteering while with us at Community Action Partnership?
References - Please give 2 People (other than relatives or partner) who would be prepared to act as referees:
Reference 1:
Name:
Telephone Number:
In what capacity do they know you?
Reference 2:
VOLUNTEER DRIVERS ONLY:
1. Do you have your own vehicle available to use for voluntary driving? YesNo
If yes, are you insured to use your vehicle while volunteering? YesNo
2. What type of driving licence do you have? Car AutomaticCar FullCar ProvisionalHGV Class 1HGV Class 2HGV Class 3MotorcyclePSV/Coach
3. Please state when you would you would be available MondayTuesdayWednesdayThursdayFridaySaturdaySunday
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