Volunteer registration form

Title (required)

Forename (required)

Surname (required)

Date of birth (required)

Home telephone (required)

Mobile telephone (required)

Email address (required)

1st line address (required)

2nd line address (required)

Postcode (required)

Emergency contact details

Emergency contact name (required)

Their relationship to you (required)

Emergency contact telephone (required)

Emergency contact address (required)

About you

Please tell us a little about why you would like to volunteer for Mountbatten (required)

Given the nature of our work, it would help us to understand a little about any personal circumstances that could impact on your role so that we can support you in your volunteer journey with us. E.g. Have you suffered a bereavement in the last 2 years? (required)

Please let us know what skills and experience you have that you would like to offer Mountbatten (for example: relevant qualifications, nursing or care experience, counselling experience, retail experience, computer skills etc). (required)

Please give us an idea of the kind of volunteering activities that would interest you. (required)

Where have you seen or heard our volunteering roles advertised? (you can select more than one) (required)

LeafletsWebsite Social mediaConnect magazineAdvertising in a non-Mountbatten publication (either online or offline)RadioA Mountbatten volunteer or staff memberOther

If you selected ’Advertising in a non-Mountbatten publication’, please tell us which publication you saw our advert.

If you selected ’Other’, please tell us where you saw our volunteering roles advertised.

Which of these prompted you to apply to volunteer? (you can select more than one) (required)

LeafletsWebsite Social mediaConnect magazineAdvertising in a non-Mountbatten publication (either online or offline)RadioA Mountbatten volunteer or staff memberOther

References

Written/Email references are required for all volunteers. Please give details of two people from whom confidential references may be obtained. If you are employed or have recently left employment the first referee should be your employer. If you have volunteered elsewhere or are still volunteering, then one referee should be your volunteer placement contact. Additional referees can be employers or friends who have known you for at least two years but must not be family members.

Referee 1 name (required)

Referee 1 address (required)

Referee 1 home telephone number (required)

Referee 1 work telephone number (required)

Referee 1 email address (required)

Referee 1 relationship to you (required)

Referee 2 name (required)

Referee 2 address (required)

Referee 2 home telephone number (required)

Referee 2 work telephone number (required)

Referee 2 mobile telephone number (required)

Referee 2 email address (required)

Referee 2 relationship to you (required)

Health

Do you have any health conditions or a disability that we should be aware of? If yes, please provide details so that we can make reasonable adjustments where necessary

DISCLOSURE OF CRIMINAL RECORDS

Because of the nature of some posts, it is important that you complete this section carefully and accurately. Applicants for posts volunteering with or having access to Vulnerable Adults are subject to an enhanced disclosure through the Criminal Records Bureau (England). Because the position for which you have applied may be covered by the Rehabilitation of Offenders Act 1974 and the Care Standards Act 2000, you are required to disclose all convictions and cautions no matter how long ago they occurred and regardless of whether the offense was committed as a juvenile or adult.

DO YOU HAVE, OR HAVE YOU EVER HAD, ANY CONVICTIONS, CAUTIONS, ADMONISHMENTS, REPRIMANDS OR FINAL WARNINGS? (required)

YesNo

ARE YOU CURRENTLY THE SUBJECT OF CRIMINAL OR LEGAL PROCEEDINGS OR POLICE INVESTIGATION? (required)

YesNo

If YES, please give details and bring to interview in a sealed envelope marked confidential. ALL convictions/cautions must be declared regardless of whether deemed as spent. Include, date, nature of summons, charge, caution, allegation, sentence or order.

If you would like a copy of our policy on the employment of people with a criminal record or to discuss any aspects of this please contact our HR Department on 01983 217319.

DECLARATION

I declare that the information I have provided and the statements I have made, including those relating to the disclosure of any criminal record and medical information, are both true and complete and that I am both mentally and physically fit to undertake the post as detailed within the role profile (if supplied). This information will form the basis of my Volunteering and become a part of my volunteer record. Should it subsequently be proved that any information is false, misleading or has been withheld I understand that Mountbatten may not seek to utilise me as a volunteer. I accept that information within this application form will be used by Mountbatten for the purpose of processing my application. Further, should my application lead to being successfully started in a volunteer capacity, information and personal data about me, including that relating to my ethnic origin and health, will be retained and processed for the purposes of monitoring and employment procedures in accordance with the Data Protection Act 1998 I understand that to complete my registration as a volunteer I will be required to: • Undertake a DBS check (formerly CRB check) if required for my chosen role. • Attend mandatory induction training, and annual refresher training thereafter. • If a suitable volunteering role is available to me, I may be required to complete a medical questionnaire. Declarations on this questionnaire will not automatically preclude anyone from volunteering but may require further exploration to ensure that I am fit for the role and that Mountbatten can take reasonable measures to accommodate my needs and minimise any risks to my health. • Attend role specific training as needed (e.g food hygiene, manual handling, COSHH) • Provide relevant professional certificates and insurance details where necessary.

Signed (print name) (required)

Date (required)

Parental/Guardian Consent (To be completed for all applicants under 18 years of age.) I confirm that I consent to the applicant volunteering with Mountbatten

Parent/Guardian signature (print name)

Date

Privacy notice

Our privacy notice can be viewed here: https://www.mountbatten.org.uk/privacy-policy This provides information as to how we use, interpret and process the data within this registration form. If you would like a printed copy, please call 01983 529511.