Volunteer Application Form (Circles)

Volunteer Application Form
Title:*

MrMrsMissMsMx
Name:*

First NameLast Name
Telephone Number:*
Email:*
Contact Preference:*

TelephoneEmail
If your preference is to be contacted by email, we are aware some people have reported our emails have been treated as junk/spam by their email provider. Please ensure you check your junk mail/spam folder for a response, or add circles@lucyfaithfull.org.uk to your safe senders list.
Date of Birth:*

DayMonthYear
Please note to volunteer with The Lucy Faithfull Foundation you must be at least 18 years old.
Address*

Street Address

Street Address Line 2

CityCounty

Post Code
Please indicate the areas in which you are able to volunteer:*

BirminghamBurtonCoventryDudleyHerefordKidderminsterLeamington SpaRedditchRugbySandwellShrewsburySolihullStaffordStoke on TrentTamworthTelfordWalsallWarwickWolverhamptonWorcester
Please indicate when you would be available to volunteer:

Most circle meetings take place late afternoon or evening. Training events take place at weekends. *

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Morning
Afternoon
Evening

Circle volunteers meet once a week as a group with the Core Member for at least the first three months of the Circle. In addition, they have contact with the Core Member at least once a week e.g. Phone call or meeting. This diminishes over the life of the Circle, which runs for a minimum of one year, and up to 18 months.
Are you able to commit this amount of time to the Circle?*

YesNo
How did you hear about volunteering with Circles West Midlands?*
Briefly describe your interest in volunteering for this project:*
Please describe any skills or background experience that you feel is relevant to this work:*
What are your hobbies and interests?*
Core members vary greatly in their patterns of offending, their choice of victim, psychological and thinking capacities and general needs. It is important to match volunteers as far as possible with individual offenders.

In order to do this, we need to be aware of any issues which could (though they may not) inhibit you from relating with the Core Members such as the type of offence(s) committed or age of victim; or any experience of sexual abuse in your personal, family or social history.
Please provide any additional information which you think could help us in matching you with a Core Member for whom we are establishing a Circle.
Is there anything else you would like us to know about you?
If you consider yourself to have a disability and have any special requirements to help you perform this role, please tell us about them here.
Under the Rehabilitation of Offenders Act (1974), having a conviction will not necessarily bar you from any volunteering activities. This will depend on the circumstances and background of your offence(s).

This role meets the requirement in respect of exempted questions under the Rehabilitation of Offenders Act 1974, and all applicants who are offered volunteering opportunities will be subject to criminal record check from the Disclosure and Barring Service before the volunteer role is confirmed. This will include details of cautions,reprimands or final warnings, as well as convictions.
Do you have any criminal convictions, including those that are spent under the Rehabilitation of Offenders Act 1974?*

YesNo
If yes, please provide brief details (if you prefer, you can contact the Circles Coordinator to discuss your circumstances).
Please provide details of two personal or professional referees whom you are happy for The Lucy Faithfull Foundation to contact for a reference:

Referees should not be family members.
Reference 1 - Name:*

First NameLast Name
Reference 1 - Telephone Number:*
Reference 1 - Email:*
Reference 1 - Address*

Street Address

Street Address Line 2

CityCounty

Post Code
Reference 1 - Relationship To You:*
Reference 2 - Name:*

First NameLast Name
Reference 2 - Telephone Number:*
Please enter a valid phone number.
Reference 2 - Email:*
Reference 2 - Address*

Street Address

Street Address Line 2

CityCounty

Post Code
Reference 2 - Relationship To You:*
Please read and sign the following statement:

I confirm that the information given on this form is, to the best of my knowledge, true and complete. Any false statement may be sufficient cause for de-selection as a Circle volunteer.
Signed:*

Clear
Date*

DayMonthYear
Should be Empty:

Volunteer Application Form

Please indicate when you would be available to volunteer:

Please provide details of two personal or professional referees whom you are happy for The Lucy Faithfull Foundation to contact for a reference:

Please read and sign the following statement: