DART Social Car Volunteer Application Form

Please give details of all driving endorsements/ convictions below

	Reason for endorsement/ conviction	Points applied	Date of Conviction	Endorsements/ convictions expiry date
1.
2.
3.

Equal Opportunities
DART welcomes volunteer applicants with all range of abilities for the skills they bring. We aim to create a positive environment that enables all volunteers to realise their full potential. So we can consider any appropriate adjustments to the volunteer environment and better support you in your role, please give details below of any disabilities or health issues (e.g. bad back).
DART adheres to the Access NI Code of Practice, and as required by the Code of Practice we have in place an ex-offenders recruitment policy as well as a policy on the secure handling, use storage and retention of disclosure information. All of these policies and Code of Practice are available on request.
Do you have any convictions that are not ‘protected’ (as defined by the Rehabilitation of Offenders (Exceptions) (Northern Ireland) Order 1979, as amended in 2014? Enhanced Access NI Checks will be carried out.**

YesNo

If you have ticked yes summarise the details below. Having a conviction will not necessarily stop you from volunteering, but will need to be taken into consideration when assessing your suitability.

Is there any reason why you cannot work with adults at risk or children?*

YesNo

Who can we contact as referees?

This can be your previous manager/ a support/care worker, landlord, tutor or another DART volunteer
1. Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityCounty

Post Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
2. Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityCounty

Post Code
Email
example@example.com
Phone Number
Please enter a valid phone number.

Declaration

Your details will be kept in accordance with GDPR. They will be held securely & confidentially. They will be accessed by authorised management.
I declare that the information I have provided is true: Signature**

Clear
Date

MonthDayYear
Date
*By signing above, you are giving consent for an Enhanced Access NI check to be carried out in line with the requirements of this role and the accompanying regulated activities you will be carrying out.
Click here to view our Equal Opportunities Policy

Click here to view our Policy on Recruitment of Ex-offenders & Disclosure Security

Click here to view our Privacy Notice
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Tell us who you are and how we can get in touch with you