Volunteer Programme / Sundial House, 140 James’s Street, Dublin 8. + 353 1 633 9226 / T + 353 1 607 4476 volunteer.coordinator@depaulireland.org / E www.depaulireland.org / W
STUDENT PLACEMENT
Version: March 2010
DEPAUL IRELAND STUDENT PLACEMENT APPLICATION FORM All information contained in this form will be treated as strictly confidential. Please refer to our Student Placement Policy before completing this application. Please complete all sections of the form to the best of your ability. If you require any assistance in completing this form please telephone the Volunteer Coordinator in Depaul Ireland (+ 353 1) 633 9226. Please type or complete in block capitals and ensure that you sign the form. Please keep the Equal Opportunities Form separate to your application form.
YOUR CONTACT DETAILS Please complete all sections – Block capitals please Forename / First name Surname
Proposed start date
Are you over 18 ?
Gender
Email Address (please print clearly)
Tutor Telephone
Tutor Email Address (please print clearly)
Yes
Proposed end date
No
Tutor Name
Home Address & Postcode
Telephone (home)
Telephone (mobile)
Telephone (work)
EDUCATION AND TRAINING If you would like to provide details of secondary schools, colleges, universities or Institute of Further Education attended, please do so below (continue on back of form if required): Period: from / to
Name / nature of establishment
Qualifications and name of course completed
NON FORMAL TRAINING Please list any other relevant qualifications or non-certified courses (Continue on back of form if required):
……………………………………………………………………………………………………………………………………………………………………………………………………………………… Volunteer Programme / Sundial House, 140 James’s Street, Dublin 8. + 353 1 633 9226 / T + 353 1 607 4476 / F volunteer.coordinator@depaulireland.org / E www.depaulireland.org / W
DEPAUL IRELAND STUDENT PLACEMENT APPLICATION FORM EMPLOYMENT If you would like to provide details of your work experience to date, please do so below (Continue overleaf if required): Period: from / to Name and Address of Employer Position Held and summary of duties
GENERAL INFORMATION Please help us to place you effectively by completing the following information about yourself. Please list the main subjects / topics on your course
What are the objectives of your placement?
What do you think you can bring to the placement in terms of skills, activities projects etc.?
How do you feel your placement would benefit Depaul Ireland and its service users?
Why have you decided to take a placement with Depaul Ireland?
Please tell us how you heard about Depaul Ireland (a friend, web site, Volunteer Centre etc.)
……………………………………………………………………………………………………………………………………………………………………………………………………………………… Volunteer Programme / Sundial House, 140 James’s Street, Dublin 8. + 353 1 633 9226 / T + 353 1 607 4476 / F volunteer.coordinator@depaulireland.org / E www.depaulireland.org / W
DEPAUL IRELAND STUDENT PLACEMENT APPLICATION FORM PLACEMENT INTEREST Is there a project that you are particularly interested in? Refer to Volunteer Opportunities Document. Back Lane Hostel
Ballymun Case Management Team
Clancy Night shelter
Orchid House
Sundial House
Tus Nua Apartments
What activity are you particularly interested in? Please explain why you choose this role
AVAILABILITY Please tick when you could be available to be on placement, if a block placement please state dates. Mondays Tuesdays Wednesdays Thursdays Fridays Saturdays Morning Afternoon Evening
Sundays
REFEREES Please provide the contact details of two referees who are in a position to assess your skill, knowledge and aptitude for volunteering with Depaul Ireland. References will only be accepted from those that know you in a professional capacity and therefore can’t be accepted from family or friends. Please complete all details. First referee Second referee Period of Employment / Study volunteering / relationship Name of referee Address of referee (Please include full address as we need to post a reference form to this address)
Daytime telephone number Email address (must be included)
VETTING OF STUDENT PLACEMENTS Because of the nature of our work with vulnerable young people and adults, we need to know the following Have you ever committed a criminal act? *
Yes
No
Do you have a criminal record? *
Yes
No
Have you any convictions and / or prosecutions, successful or not, pending, spent or completed? *
Yes
No
Access NI Clearance / Garda Vetting provided by college?
Yes
No
* NB. This includes ‘spent’ convictions. If the answer is yes, we may need to discuss it with you. It will not necessarily prevent you from becoming a volunteer. If you wish, you may give further details below.
DECLARATION I declare that the information given on this form is complete and correct to the best of my knowledge and that I understand that inaccurate or false information given may result in an offer of placement being withdrawn. Applicants Signature Date
……………………………………………………………………………………………………………………………………………………………………………………………………………………… Volunteer Programme / Sundial House, 140 James’s Street, Dublin 8. + 353 1 633 9226 / T + 353 1 607 4476 / F volunteer.coordinator@depaulireland.org / E www.depaulireland.org / W
DEPAUL IRELAND STUDENT PLACEMENT APPLICATION FORM EQUAL OPPORTUNITIES IN STUDENT PLACEMENT As part of Depaul Ireland’s commitment to making equal opportunities a reality, it is our policy to recruit Student Placement on the basis of their ability and their suitability for the post they are applying. We are committed to ensuring that no volunteer applicant or volunteer receives less favourable treatment than others. We are monitoring our volunteer applicants in order to assess our performance, and would be grateful if you would answer the following questions. The information you provide will be treated in strict confidence and will not be used as part of the selection process. Volunteer role applied for Where did you see this position advertised?
Do you consider yourself to have a disability?
Gender
Age Category (please tick the relevant box) 18-25
25-35
35-45
45-55
55-65
65+
I describe my ethnic origin as (Please tick relevant boxes) White
Irish Traveller
Black: Caribbean
Black: African
Irish
Pakistani
Bangladeshi
Chinese
Indian
Other (Please specify)
Please return this page along with your application. If you do not wish to answer all or any of these questions on this page, your application will not be affected in any way. Completed Application Forms and Equal opportunities form should be returned to: Stuart Garland, Volunteer Programme, Depaul Ireland, Sundial House, 140 James’s Street, Dublin 8, Ireland.
……………………………………………………………………………………………………………………………………………………………………………………………………………………… Volunteer Programme / Sundial House, 140 James’s Street, Dublin 8. + 353 1 633 9226 / T + 353 1 607 4476 / F volunteer.coordinator@depaulireland.org / E www.depaulireland.org / W