Linking Lives Eastbourne Volunteer

Volunteer application

Please fill out the form carefully.
Your Name*

PrefixFirst NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Address*

Street Address

Street Address Line 2

TownCounty

Post Code
E-mail*
example@example.com
Mobile Number
Phone Number
Church*
Occupation
Languages
Ethnic origin*

White - BritishBritishAsianEuropeanChineseFilipinoIndianMixed Ethnic GroupWhite - OtherOther
Medical Problems which may affect your work as a volunteer:
Allergies (including animals)
Please Check the Boxes Below to Help Us Know Which Tasks You Could Help With*

Home Visits - Regular visiting a Link Friend at homeTelephone Befriender - Regularly phoning a Link Friend at homeTelephone Plus - Regularly phoning a Link Friend at home, with occasional outingsAlongside - Going to specific activities with a Link Friendfor 3 - 6 months to facilitate them becoming part of a group / network
Would you be interested in befriending someone with anyof the following? You can tick more than one box (or none)

DementiaMental Health Issues
Hobbies or interests that may help us in matching you to a Link Friend:
Where did you hear about Linking Lives Eastbourne?*
References

We require two references from people who have known you longer than 1 year. First from a leader in your church; secondly a character reference - preferably a previous volunteer / employed role, but specifically someone who is not family. Please provide contact details below:
Church Reference
NameFirst Name*   Last Name*
Email   Email*
How do you know this person?   Type a label*
How long have you known this person?   Type a label*
2nd Character Reference
NameFirst Name*   Last Name*
Email   Email*
How do you know this person?   Type a label*
How long have you known this person?   Type a label*
Declarations

Please confirm your agreement or not with the following.
Confidentiality Agreement: In the course of your befriending you may have access to confidential information and records about your Link Friends and sometimes other Volunteers. It is therefore vital that you treat all information about your Link Friends and other Volunteers as confidential.Our Link Friends and Volunteers must be able to have confidence that personal information will never be released. Please agree below to confirm that you accept your responsibility to maintain the confidentiality of your Link Friend and other Volunteers:*

I agreeI do not agree
All the personal information we gather about you is necessary (a ‘legitimate interest’) for our organisation to work with you as a volunteer.(This is explained in more detail within our Privacy Policy which can be viewed at any time.) We are required to obtain your agreement to store your information and share it, only as necessary, within our team and/or to professional agencies to obtain relevant advice and support. I agree to my information being stored and shared securely by Linking Lives Eastbourne.*

I agreeI do not agree
Safeguarding & DBS

This volunteer post meets the requirements in respect of exempted questions under the Rehabilitation of Offermnders Act 1974.

Any applicants for this post who become volunteers for this organisation will be subject to a Disclosure and Barring Service Check (DBS) before the appointment is confirmed. This will include details of cautions, reprimands or final warnings as well as convictions.
NB A criminial record will not automatically bar a person from successfully taking up this post.
Conviction History: Have you had any criminal convictions, or are you at present the subject of a criminal investigation / pending prosecution?*

YesNo
Have you ever received a caution, reprimand or warning that might be recorded in your DBS record?*

YesNo
If you have answered 'yes' to either of the above, please make contact with the office to disclose:
- The natures of the offences
- The reasons and circumstances
- The dates
- The sentence received
- Any other pertinent information
Police Investigations: Have you ever been the subject of a police investigation that didn't lead to a criminal conviction?*

YesNo
Have you ever had any allegation made against you, which has been reported to and investigated by Social Services / Adult Social Care?*

YesNo
Has there ever been any cause for concern regarding your conduct with vulnerable adults?*

YesNo
If you have answered 'yes' to any of the above, please contact the office to disclose:
- natures of the investigations
- allegations or concerns
- dates
- please include any disciplinary action taken by an employer in relation to your behaviour with adults
- any other pertinent information
Declarations
I consent to criminal records check if appointed to the volunteer position for which I have applied. I am aware that details of pending prosecutions, previous convictions, cautions, or bind-overs against me may be disclosed along with any other relevant information that may be known to the policy.*

I agreeI do not agree
I agree to inform the Scheme Coordinator (Safeguarding Lead) if I am convicted of an offence after I take up my volunteer post within Linking Lives Eastbourne. I understand that failure to do so may lead to the immediate suspension of my work with vulnerable adults.*

I agreeI do not agree
I agree to inform the Scheme Coordinator (Safeguarding Lead) if I become the subject of a police and / or social services investigation. I understand that failure to do so may lead to the immediate suspension of my work with vulnerable adults.*

I agreeI do not agree
The role of working with vulnerable adults as a Volunteer Befriender with Linking Lives Eastbourne falls within the scope of regulated activity. Please confirm that you are not barred from working with vulnerable adults.*

I confirm that I am not barred from working with vulnerable adultsI advise that I am barred from working with vulnerable adults
I confirm the information in this application form to be correct and any misleading or falsification of information may be proper cause for rejection or termination of this placement.*

I agreeI do not agree
I confirm that I will complete all necessary paperwork and attend any required training as part of my preparation to become an active volunteer with Linking Lives Eastbourne.

I agreeI do not agree
I am happy to receive newsletters and updates about the general work of the charity.*

YesNo
Referee 1
Name   First Name   Last Name
Email
How do you know this person
Should be Empty:

Volunteer application

References

Declarations