Carers’ Time Off Volunteer Application Form
Confidential                                                                                                                                                                                                                                                

Registered Charity No.1049278
	
Full Name		
Address		
	
Post Code				

Telephone No (Home)		
Telephone No (Mobile)		

Email Address	

If applicable, do you have use of a car for your voluntary work?		
Interests, hobbies & skills

Please state when you would be available (e.g. school hours, evenings, weekends, specific days of the week) and approximately how much time you wish to give.		

Please give details of any experience, including gained at work, you feel may be relevant		
Please give details of any training or qualifications you feel may be relevant		
Please give details of any other voluntary work you are or have been involved with 		
Do you have any health problems that you feel we should know about? If so, please give details. 		
How did you hear about us?		
I confirm that the above information is correct to the best of my knowledge at this time. 	
Volunteer’s signature 		Date		
Please Turn Over	
References
Please give details of 2 people (not related to you) who are willing to supply references for you.
 If possible, include an employer, tutor, the Co-ordinator of any present or previous voluntary organisation with which you have been involved, or someone who has known you
 for at least 5 years.
	
Name:
Address:   

Post code:
Telephone:

Email:                                                                    	Name:
Address:

Post code:
Telephone:

Email:                                                                      	

Rehabilitation of Offenders Act

Because of the nature of the voluntary work for which you are applying, this post is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. Applicants are therefore not entitled to withhold information about convictions which for other purposes are ’spent’ under the provisions of the Act and, in the event of employment any failure to disclose such convictions could result in dismissal or disciplinary action by the Authority. Any information given will be completely confidential and will be considered only in relation to an application for positions to which the Order applies.

Do you have any previous convictions? YES/NO.
If YES, this will be discussed with the Manager. 

Criminal Record Disclosure

In the interests of service users and volunteers, it is the policy of Carers’ Resource to apply for a Criminal Record disclosure for every volunteer and staff member of our Projects.

Evidence of a past record of offending will not necessarily exclude you from volunteering. Each individual case will be judged on its own merit and within the guidance of our Equality and Diversity Policy and The Rehabilitation of Offenders Act. Each Applicant will receive a copy of their own Criminal Record disclosure. The information contained within a disclosure will be treated as completely confidential.

Disclosure Information will not be kept longer than is necessary, and when no longer necessary it will be destroyed. In no circumstances will the information contained in a disclosure be made available to any third party. If you wish to discuss this procedure with the Manager, please feel free to do so. 
A copy of the Carers’ Resource Policy Statement on the Recruitment of Ex-Offenders is available on request. 

Record of Volunteer’s Consent - Data Protection Act 1998

As part of our records we may need to record sensitive data about you.  In order to comply with the Data Protection Act 1998 we must obtain your consent to keep this information. Everything you tell us will be treated in accordance with Carers’ Resource’s confidentiality policy and will only be shared if there is a specific reason for doing so.
Sensitive data is defined as information relating to racial or ethnic origin, political opinions, religious or other beliefs, trade union membership, health, sexual life, and criminal proceedings and convictions.
For the purposes of the Act the Data Controller is Carers’ Resource.

I give my consent to Carers’ Time Off recording sensitive information about me.

Volunteer’s signature		Date