Volunteer Application Form

Name *

Address *

Post Code *

Mobile Number

Email

Date of Birth

Are you employed?

Occupation

Employers Name/Organisation

Are you a student?

Courses being studied

List skills, training and previous experiences (paid or unpaid)

Driver's Licence

Do you have a current First Aid Certificate?

Do you have any significant restrictions/ limitations which may limit the type of voluntary service you can undertake?

If yes, please specify:

Reson for applying to undertake voluntary service assisting children and adults with multiple and severe disabilities

To help with matching you to clients, what hobbies and interests do you enjoy now or have enjoyed in the past?

What is your Availability?

AMPM
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

If needed, I'm prepared to undertake training


Name

Phone number

Relationship to applicant

Name

Phone number

Relationship to applicant

If you are under 18 years of age, please provide an additional referee of a parent/ guardian

If yes, please include, Name, phone and relationship to applicant:

Name

Relationship to applicant

Home Phone

Work Phone

Mobile Phone