Volunteer Application Form

Volunteer Application Form
Step 1 - About You
Name*

PrefixFirst NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Post Code
Post code
Email
example@example.com
Preferred contact number
Mobile/Secondary number
Which area would you like to volunteer in?
Have you been into one of our shops?

YesNo
Which of our shops have you been into?

When would you like to volunteer?

Rows	Morning	Afternoon
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Please explain why you would like to join Claire house as a volunteer? And what you would like to get out of the role:
Do you have a skill, talent, hobby or experience, you think Claire House could benefit from, and that you would like to share?
Who should we contact in an emergency?

Emergency Contact Name

Relationship to You

CityState / Province

Emergency contact Number
Do you have any medical conditions or disabilities that may affect your volunteering, or that staff need to be aware of?

YesNo
Please provide further information or indicate if you would like to discuss anything with a member of staff. (Claire House reserves the right to request further medical information at our expense):
Do you require Claire House to make any reasonable adjustments to make your volunteering role easier?

YesNo
Please tell us about any reasonable adjustments here.
Claire House Children's Hospice is committed to being an equal opportunities organisation. Please state any relationship you have to Claire House, a staff member, family or volunteer:

Staff MemberVolunteerClaire House ChildClaire House FamilyNone of the above
Our new database allows us to link you to your spouse or partners details, a staff member or a Claire House family. This will limit how many letters one household receives, and helps us know what information we should and shouldn't send to you. Please can you explain your relationship to the Claire House family, staff member, or volunteer below:
Have you ever been convicted of a criminal offence?*

YesNo
Please give details
Should your volunteer application be unsuccessful Claire House will destroy your information in accordance with Data Protection Legislation. Any information given on this form is confidential and covered by the Data Protection Act 1998. Any offer of a volunteer post is subject to satisfactory references and a check from the Disclosure and Barring Service (DBS) (if appropriate to the role). Having a criminal record will not necessarily bar you from volunteering with us. Please contact Voluntary Services if you wish to discuss this further.
How did you hear about Claire House?

Step 2 - The Small Print
Confidentiality Statement*
Health and Safety Agreement*
Disclaimer*

Step 4 - References

Each Claire house volunteer role requires two references – who can we contact? Please note you cannot use relatives.
Referee 1 Name

First NameLast Name
Referee 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Referee 1 Email
example@example.com
Referee 2 Name

First NameLast Name
Referee 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Referee 2 Email
example@example.com
Thank you for taking the time to complete this form.

A member of the Volunteer Services Team will be in touch within three working days to discuss your enquiry
Should be Empty:

Volunteer Application Form

Step 1 - About You

Step 2 - The Small Print

Step 3 - Equality and Diversity (optional)

Step 4 - References

Thank you for taking the time to complete this form.