Northern Ireland Appropriate Adult Volunteer

MindWise Volunteer Form
What volunteer post are you applying for? Please tell us the name and location.*
Title
First Name
Last name
Yes, I give permission to store and process my data

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Address*
Postcode
Email address
Phone number*
Why are you interested in this volunteering opportunity?*
Hours available for volunteering

Sunday AMSunday PMMonday AMMonday PMTuesday AMTuesday PMWednesday AMWednesday PMThursday AMThursday PMFriday AMFriday PMSaturday AMSaturday PM
Please give us a brief outline of any experience you may have had of volunteering and in which organisations.*
Please can you give us a brief outline of you employment history?
Please provide two referees, if possible from a former employer or through education. If this is not possible please provide details of a professional or friend. Please include a name, address and phone number/email address.*
Gender
Date of birth
Nationality
Ethnicity
Sexuality
Community background you associate with
A person has a disability if he or she has “a physical or mental impairment which has a substantial and long-term adverse affect on his or her ability to carry out normal day-to-day activities”. Do you consider yourself to have a disability?
Process my application

Process my application
Criminal Conviction Declaration
What volunteer post are you applying for? Please tell us the name and location.*
Your experience - Are you currently subject to inclusion on the ADULTS and / or CHILDREN's barred list? *
Please provide any other information you feel may be relevant such as: • The circumstances of the offence • A comment on the sentence received • Any relevant developments in your situation since then • Whether or not you feel the conviction has relevance to the post.
I declare that any are answers are complete and correct to the best of my knowledge. I give consent for an Access NI Enhanced check to take place at a later stage and for this information to be shared as part of MindWise risk assessment process. Access NI’s Code of Practice is available from: https://www.nidirect.gov.uk/publications/accessni-code-practice*

YesNo
Please enter your name to sign this form*
Please verify that you are human*
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MindWise Volunteer Form

Criminal Conviction Declaration