Volunteer Application Form
Step 1 - About You
Name
*
Prefix
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / 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?
Yes
No
Which of our shops have you been into?
When would you like to volunteer?
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
City
State / 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?
Yes
No
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?
Yes
No
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 Member
Volunteer
Claire House Child
Claire House Family
None 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?
*
Yes
No
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?
Please Select
Claire House magazine
Friend or relative
Internet
Staff member
Local voluntary centre
Media/local press
Shop
Hospice
Social media
University/college/school
Personal experience
Other
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Step 2 - The Small Print
Confidentiality Statement
*
Health and Safety Agreement
*
Disclaimer
*
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Ethnic Origin
Please Select
African
Any Other Origin
Arab
Asian
Asian / Asian British of Any Other Origin
Asian / Asian British of Bangladeshi Origin
Asian / Asian British of Indian Origin
Asian / Asian British of Pakistan Origin
Asian British
Bangladeshi
Black / Black British of African Origin
Black / Black British of Any Other Origin
Black / Black British of Caribbean Origin
Black British
Chinese
Egyptian
Mixed Race of Any Other Origin
Mixed Race of White & Asian
Mixed Race of White & Black African
Mixed Race of White & Black Caribbean
Mixed White & African
Mixed White & Asian
Mixed White & Caribbean
Not Known
Other
Pakistani
White British
White European
White Irish
White of Any Other Origin
White of British Origin
White of Irish Origin
Step 3 - Equality and Diversity (optional)
Please help us to monitor our volunteer recruitment procedures. This information will be used for monitoring purposes only and will not be used for any purpose other than monitoring. By completing and returning this form you are providing Claire House with your explicit consent to this use. The confidential monitoring form does not constitute any part of the recruitment and selection process for volunteers.
GENDER
Male
Female
Transgender
Non-binary
Prefer not to say
Let me type...
Do you identify as someone living with a recognized disability as outlined in the Disability Discrimination Act?
Yes
No
Do not wish to disclose
Date of birth
-
Day
-
Month
Year
Date
What is your current working pattern?
Full Time
Part time
Not working
Retired
Prefer not to say
What is your religion or belief?
No religion or belief
Buddhist
Christian
Hindu
Jewish
Muslim
Sikh
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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 Name
Last Name
Referee 1 Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Referee 1 Email
example@example.com
Referee 2 Name
First Name
Last Name
Referee 2 Address
Street Address
Street Address Line 2
City
State / 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
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