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Volunteer PFF Application Form
Ref. No
Please use this form to give us as much information as you can. All information on this form is strictly confidential.
Mr / Mrs / Ms / Miss Miss (please indicate)
Name: ______________________________________
Home Address: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Date of Birth: __________________________ Tel No:
Day:_________________________
Evening:_____________________________
Mobile:_______________________
Email :______________________________
Employer:____________________________________________________ Address: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Do you have a driving licence?
No / NO YES
Do you have use of a car?
No / NO YES
All applicants will have to undergo checks by the Criminal Records Bureau before they are allowed to become a volunteer PFF co ordinator. Have you ever been convicted of any criminal offence?
No YES
/ NO
If YES please give details on the following pages of this application. A conviction, bind over or caution will not automatically disqualify you from working as a volunteer, but any failure to disclose such information could result in dismissal.
PFF volunteer co-ordinator recruitment pack September 2012
Have you had any experience of working (paid or voluntary) with older people? If YES, please give details
YES No
/ NO
Please give details of any training courses you have attended that are relevant to this role.
What skills, knowledge, abilities or life experiences do you have that you feel might be relevant to this work?
Please say what made you consider becoming a volunteer PFF co ordinator and any relevant facts about yourself that will support your application (Continue on back sheet if necessary)
PFF volunteer co-ordinator recruitment pack September 2012
Any disability or chronic physical or mental health condition? If YES, please give details
YES / NO No
Any physical dependencies that you have had during the past two years on either drugs or alcohol? YES No / NO If YES, please give details.
Please give details of any previous convictions, bind overs or cautions Offence / Circumstances
Date
Please supply the names and addresses of two referees. (eg. employer, health visitor, vicar etc.) Name :……………………………….
Name:…………………………………..
Address:…………………………….
Address:……………..…………………
………………………………
………………………………..
………………………………
………………………………..
………………………………
………………………………..
Telephone No:………………………
Telephone No:…………………………
How known to you:…………………
How known to you:…………………...
No May we contact this referee now? YES/NO
No May we contact this referee now? YES/NO
PFF volunteer co-ordinator recruitment pack September 2012
Please use this page to add any further information that you think will be useful for us to know.
Signature………………………………………..
Date………………………………….
You will be required to provide proof of identity eg. passport, photo driving licence) when you attend for an interview. The information provided in this application is true and correct. I understand I will be expected to attend training, networking and supervision sessions in addition to the time spent as a PFF co ordinator. I have the time available to fulfil this role.
Once completed please post or fax along with the equal opportunites form to: The Hampton Trust Fairways House Mount Pleasant Rd Southampton SO14 0QB Tel: 023 8021 3520 Fax: 023 8021 3530
Submit by Email
PFF volunteer co-ordinator recruitment pack September 2012
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EQUAL OPPORTUNITIES RECRUITMENT MONITORING FORM We are an equal opportunity employer and positively encourage applications from suitably qualified and eligible candidates regardless of sex, race, disability, age, sexual orientation, or religion or belief. To enable us to improve and monitor our equality processes, please complete the section below and note that this information is confidential and will only be used only for statistical analysis, it will be separated from your main application immediately upon receipt and shredded once analysed. We would, therefore, be grateful if you would complete the details below in line with our commitment to promoting diversity. The information will be held in compliance with the Data Protection principles as set out in the Data Protection Act 1998. Should you become an employee, we will seek periodic confirmation from you as to its accuracy. Please √ as appropriate
Position applied for: ……………………………………………………………………..….………. How did you hear about this post?: …………………………………………………..…….….…... If through an advertisement, which publication?: …………………………………..…………….. Gender Male
Female
I consider myself to be transgender
I prefer not to answer
Age < 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70+
I prefer not to answer
Personal Status Single
Married / Civil Partnership
Cohabiting
Separated
Divorced
Widowed
I prefer not to answer Ethnic Origin I would describe my Ethnic Origin as:
White - British
Asian or Asian British - Pakistani
White - Irish Any other white background
Asian or Asian British – Bangladeshi Any other Asian Background
Mixed – White and black Caribbean
Black or black British – Caribbean
Mixed – White and black African Mixed – White and Asian
Black or black British – African Any other black background
Any other mixed background Asian or Asian British - Indian
Chinese Other – please specify
Nationality Please state: Disability The Disability Discrimination Act 1995 defines disability as a “physical or mental impairment, which has a substantial and long term adverse effect on a person’s ability to carry out normal day-to-day activities” Do you consider yourself to be a disabled person? Yes
No
I prefer not to answer this question If you answered Yes, please give details:
Sexual Orientation Bisexual
Heterosexual
Gay man
Other - please specify
Gay woman / lesbian
I prefer not to answer this question
Religion or Belief Christian
Catholic
Sikh
Protestant
Buddhist
Hindu
Jewish
Muslim
No religion
I prefer not to answer this question
Other – please specify:
Thank you for taking the time to complete this form.