Volunteer application form - Eden Valley Hospice

Volunteer form

"*" indicates required fields

Step 1 of 4

25%

Name*

First Last

Email*

Enter Email Confirm Email

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Area of Interest

Which Volunteering Opportunity you are interested in?*

How did you hear about us?

Personal information and needs

Have you suffered a close bereavement in the past two years?*

Yes

If yes, please provide details*

Do you consider yourself to have a disability or condition which would prevent you from undertaking the role of volunteer?*

Yes

If yes, please provide details*

Do you require any adjustments to be made to assist you to undertake the role of a volunteer?*

Yes

If yes, please provide details*

Personal Skills, Experience and Comments

Please summarise, in a maximum of 250 words, why you feel you would be suitable for the volunteer opportunity you are applying for.

Please describe any skills you have that you think may be a benefit to the Hospice, e.g. computer skills, great at DIY, used to work in a shop, etc. Include any voluntary and paid work, general life experience, training and education.

Any Other Comments

Personal Reference 1

Please give details of two people (other than relatives) we can approach for references and are able to comment on your suitability as a volunteer. You must have known these people for two years or longer.

Reference 1 Name*

First Last

Reference 1 Email*

Enter Email Confirm Email

Reference 1 Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Reference 1 Phone*

Reference 1 Relationship to you*

Personal Reference 2

Reference 2 Name*

First Last

Reference 2 Email*

Enter Email Confirm Email

Reference 2 Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Reference 2 Phone*

Reference 2 Relationship to you*

Criminal Convictions

Due to the nature of the work involved within the Hospice and the other associated businesses for which you are volunteering, this post is exempt from the provisions of Section 4 (2) of the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975. Dependent on the role, successful applicants may be required to obtain Disclosure and Barring clearance. You are therefore not entitled to withhold information about convictions which for other purposes are classed as “spent” under the provisions of the Act. Failure to disclose such convictions may result in you being unable to work as a volunteer at the Hospice. If you wish to discuss this further please contact a member of the People Services Department at the Hospice on 01228 810801.

Have you ever been convicted, cautioned, reprimanded or given a warning for a criminal offence that is not protected, as defined by the Rehabilitation of Offenders Act 1974?*

Yes

If yes, please give more information*

Confidentiality Statement

I understand that whilst volunteering at Eden Valley Hospice & Jigsaw I may see information about patients and their families, patient care, fundraising, financial information, staff, volunteers, sponsors and suppliers. Any information I receive is given in the strictest confidence and will not be disclosed to anyone outside of Eden Valley Hospice & Jigsaw, both during my time volunteering and after. Eden Valley Hospice & Jigsaw will deem any breach of confidentiality as a serious offence and appropriate action will be taken.*

I agree

Communications

We'd really like to keep you up to date on information regarding your volunteering that we feel you may want to know about. This includes our Volunteer Newsletter, thank yous and invitations to events. Please confirm your preferred method of communication by ticking the relevant boxes below.

Telephone

Post

If you don’t wish to receive any communications from the Hospice, please do not tick any boxes.

Work Permit

Do you need a work permit to work in the UK?*

Yes

Health and Safety Agreement

All volunteers must abide by Eden Valley Hospice and Jigsaw safety procedures and policies. We would remind you that volunteers have duties under the Health and Safety at Work Act to: Take reasonable care of your own health and safety and that of anyone affected by what you do. Be aware of how your activities may affect other people. Co-operate with Eden Valley Hospice & Jigsaw rules and procedures that are in place for your health and safety. Do not misuse any equipment provided for Health and Safety reasons. I hereby state I have read and understood the Health and Safety Agreement and will abide by its terms.

Health and Safety agreement

I agree

Declaration

I hereby confirm that I wish to apply as a volunteer with Eden Valley Hospice & Jigsaw (EVH) and confirm the information contained in this application is true and accurate. I further grant the charity permission to take up such references as they feel appropriate to my application and, if required, to carry out the police check required by law for me to work with ‘vulnerable’ people. I further give Eden Valley Hospice & Jigsaw permission to process the information provided in accordance with the UK General Data Protection Regulation (UK GDPR). Under UK GDPR I understand that the details provided on this application form will be used only for the purpose of volunteer recruitment and, if successful, to administer my role as a volunteer at Eden Valley Hospice & Jigsaw (unless indicated in Communications above). EVH will not pass your details onto any third parties without prior consent. For more information explaining how we use your information please see our Employee and Volunteer Privacy Notice. By submitting the form you are agreeing to the above.

Comments

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