Online Volunteer Application Form

Volunteering

Title *

Forename(s) *

Surname *

Age *

Address *

Postcode *

Home Telephone

Mobile Telephone

Preferred Method of Contact (Hold down ctrl to select multiple answers)

Please give FULL details of two people we can contact for a reference (not relatives) PLEASE NOTE THIS SECTION IS MANDATORY

Title *

Full name *

Address *

Email address *

Relationship *

Second reference

Title *

Full name *

Address *

Email address *

Relationship *

Emergency Contact (Please provide contact details of someone we can contact in case of an emergency)

Title *

Name *

Relationship *

Address *

Home telephone *

Mobile telephone *

How did you hear about volunteering opportunities at St Luke’s Hospice Plymouth? (Hold CTRL to select more than one option)

If Other Please Specify

Why do you want to volunteer for St Luke’s Hospice Plymouth? (Hold CTRL to select more than one option)

If Other Please Specify

Tell us about yourself. What notable skills or experience could you bring to a volunteering role? *

Which volunteer role are you interested in? Your first choice of role is:

Which other roles are you interested in? (Hold CTRL to select more than one option)

Please specify which shop/s if retail role. (Hold CTRL to select more than one option)

Please select days and times that you would be available to volunteer. (Hold CTRL to select more than one option) *

Are you legally eligible to volunteer in the UK? (St Luke’s is unable to sponsor volunteering visas)

Rehabilitation of Offenders Act 1974 – Exemption form S4(2)

Having a criminal record will not necessarily be a bar to involvement as a volunteer with St Luke’s Hospice Plymouth.

Information on criminal records will be discussed in an open and measured way with the manager and, dependant on the role, may require further checks under the Rehabilitation of Offenders Act 1974 – Exemption Form S4 (2). Depending on your role, you may be required to complete a self-disclosure of any unspent convictions.

Signature *

Date *

Your Information

In accordance with the General Data Protection Regulations (GDPR), the personal information on this form will be used in the recruitment and selection of volunteers and may be disclosed to all those who need to see it within the organisation. It will also form the basis of the confidential volunteer record which we will refer to for legitimate purposes or legal reasons for as long as you are a volunteer. It is important that you advise us of any changes to your personal details so that our records remain current.

St Luke’s Hospice Plymouth will never share your data or personal information with any external organisation. In some areas of activity where direct contact with patients or young people is required, a DBS check will be necessary. More information about how we collect, use, store and dispose of your personal data, as well as your rights, can be found in our full Privacy Notice or by visiting www.stlukes-hospice.org.uk/information-protection

Confidentiality

You may not during or after leaving St Luke’s Hospice Plymouth disclose to anyone any information of a confidential nature relating to St Luke’s or its business or patients. Any breech of this clause could lead to prosecution under relevant legislation.

Declaration

I confirm that the information I have given is true and complete. I understand that a false or misleading statement may result in my volunteering arrangement being terminated.

Upon completion of the application form please fill out the Equal Opportunities Form .

Back to Volunteering

Online Volunteer Application Form

Volunteering

Upon completion of the application form please fill out the Equal Opportunities Form .

Back to Volunteering

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