LGBT Excellence Centre Unleashing Wales’ Potential - Empowering Communities to Flourish
VOLUNTEER APPLICATION FORM This form should be used by anyone wishing to volunteer for the LGBT Excellence Centre Wales Full Name
Address
Post code
Telephone
Mobile
For use in emergency only Contact Person Contact Telephone Position Applied for Your availability (please tick as appropriate) MON TUE
WED THU FRI
SAT
SUN
AM PM EVE Please tell us about your work experience, qualification and skills including any voluntary work What type of work are you interested in doing? Any other information to support your application Rehabilitation of Offenders Act 1974: Do you have any unspent convictions? If yes, please specify
LGBT Excellence Centre 376 Newport Road, Cardiff, CF23 9AE. Tel. 029 20451868 Website: www.ecwales.org.uk E-mail info@ecwales.org.uk Company Registration Number 6407962 Charity Registration 1123355
Yes
No
LGBT Excellence Centre Unleashing Wales’ Potential - Empowering Communities to Flourish
References If you have worked in the past five years, at least one reference should be obtained from your last employer. If not, give the names of people who you know well. Referee One Name Address
Tel
In what capacity do you know referee one? Referee Two Name Address
Tel
In what capacity do you know referee two? Declaration I understand that any offer of volunteering with the LGBT Excellence Centre (Wales) Limited is subject to satisfactory references, and binding in honour only. In accordance with the 1998 Data Protection Act, I agree that the LGBT Excellence Centre may hold and use personal information about me for volunteering reasons and to keep in touch with me. This information, including that contained in this form can be stored on either manual or computer files. It will be held securely and only accessed by authorised personnel. Please tick this box if you agree to the above statement. Signature
Date
If you are submitting this application by e-mail, you will be asked to sign you application in person.
LGBT Excellence Centre 376 Newport Road, Cardiff, CF23 9AE. Tel. 029 20451868 Website: www.ecwales.org.uk E-mail info@ecwales.org.uk Company Registration Number 6407962 Charity Registration 1123355
LGBT Excellence Centre Unleashing Wales’ Potential - Empowering Communities to Flourish
Confidentiality Undertaking Full Name
I undertake to treat all information concerning the LGBT Excellence Centre Wales (including information relating to any member, client, service user, or associate of the organisation), which comes to my knowledge during the course of my involvement with the organisation, as strictly confidential. I further undertake that I will not, during the course of my involvement (except in the proper performance of my duties) or thereafter, divulge any such confidential information to any third party whatsoever nor will I make use of such information for my own or another person’s benefit. I further undertake that I will use my best endeavours to prevent the use or disclosure of such confidential information to third parties. I understand that a breach of this undertaking may result in my dismissal and/or legal action. Signed
Dated
If you are submitting this application by e-mail, you will be asked to sign you application in person. Notes
“Confidential Information” includes (but is not limited to) all documentary and other information relating to the LGBT Excellence Centre (Wales) Limited, its members, clients, service users and associates, potential members, clients, service users and associates, including documents, new business plans and information regarding spending, details of finances and staff, design, product details, and future product ideas and other such documentation and information which the Excellence Centre specifies from time to time as confidential information.
This undertaking is without prejudice to the terms and conditions of your volunteering involvement with the LGBT Excellence Centre (Wales) Limited relating to confidentiality.
LGBT Excellence Centre 376 Newport Road, Cardiff, CF23 9AE. Tel. 029 20451868 Website: www.ecwales.org.uk E-mail info@ecwales.org.uk Company Registration Number 6407962 Charity Registration 1123355