VOLUNTEER COMMUNITY MENTOR APPLICATION FORM

Registered Charity Number 299052
VOLUNTEER COMMUNITY MENTOR APPLICATION FORM
Name:
Date of Birth: *

Day Month Year
Date
Married/Single
If married, previous name:
Address
Postcode:
Home Tel No:
Mobile No:
Email:
example@example.com
How long have you lived in this area?
Place of Birth:
Number of Children
Age(s)
Please list your hobbies/interests:
Are you, or have you ever been, a helper in Social Work or any other Voluntary Organisation? Please give details:
Please give details of any training or other experience which you feel will be helpful in this work:
What do you imagine you would be able to offer a client?
What times would you be available for volunteer work?

Anytime Specific Times (please specify)
Days & Times
Do you have access to a car, which you would be prepared to use?

Yes
Have you ever been convicted of a criminal offence? If so please give details. We are required to submit a police check with the Disclosures and Barring Service on behalf of all volunteers.
If you have not been living at your present address for the last five years, please give details of previous addresses for the last five years, with dates. (Required for the police check).
Any other work or personal information which you feel would be useful:
Have you previously applied to become a Volunteer with the One to One Project?

Yes No
If yes, when was this?
Full Name and Address of two referees who we will contact to support your application. (One must be from your G.P. to state that there is not a mental health/medical reason why you should not do this work. The other should be a character reference
G.P
Name
Address
Address
Post Code
Post Code
Signature:

Clear
Date:

Day Month Year
Date
Should be Empty:

Registered Charity Number 299052

VOLUNTEER COMMUNITY MENTOR APPLICATION FORM