VOLUNTEER REGISTRATION FORM

Personal Information
Name*

First NameLast Name
Email*
example@example.com
Contact number (please include country/area codes or use +)
Date of birth*

MonthDayYear
Date
Gender

MaleFemaleNon-BinaryPrefer not sayOther
Pronouns
Nationality*
Do you have any dependants? This includes your partner or spouse, and children*

YesNo
Are you are affiliated with a YMCA or agency? If yes, please state which one.

Volunteering programme
Please pick one from the following options:*

Medical Background
Do you suffer from any of the following:*

EpilepsyAsthmaDiabetesAllergiesNone of these
Please state allergies (if applicable)
Have you ever received treatment for any medical issues e.g. depression, eating disorders, addictions etc? Please indicate YES/NO and provide details.
Answering yes, will not exclude you from consideration.
Are there any limitations on your ability to carry out duties or participate in activities? Please indicate YES/NO and provide details.
Answering yes, will not exclude you from consideration.
Do you have any visible tattoos or body piercings? Please indicate YES/NO and provide details.
Answering yes, will not exclude you from consideration.

Skills & Motivation
Please outline your relevant and specific skills: e.g. group work skills, interpersonal skills etc*

0/200
Please list any other talents, skills, experiences or qualifications relevant to your application*

0/200
Please outline your reasons for wanting to volunteer*

0/200

DECLARATION OF CRIMINAL BACKGROUND

The nature of the job for which you are applying will bring you into direct contact with children and young people, either as service users in their own right or the children of service users. It is also considered to be a Regulated Position.
Is there any reason why you cannot work in a regulated position with young people? *
Accordingly this post is exempt from the provisions of the Rehabilitation of Offenders Act 1974. Therefore you are required to disclose information about all criminal convictions, both current and spent. YMCA Ireland have a policy on the Recruitment of Ex Offenders which is available on request or which can be found on our website - www.ymca-ireland.net.

Declaration of a conviction will not necessarily mean disqualification from appointment. However, if it is subsequently found that you failed to declare a conviction, this will be regarded as gross misconduct, which could lead to your employment being terminated.

This post involves *regulated activity’ under the Safeguarding Vulnerable Groups (NI) Order 2007, therefore if your application is successful,YMCA Ireland will be required to undertake an ACCESSNI Enhanced Disclosure of Criminal Background before successful applicants can take up position.

The information you provide will be used solely for the purposes of this recruitment exercise and will be used for no other purpose.
Please give details, including date, offense and sentence of all criminal convictions [spent and unspent] below. If none, please write none, sign and date.*

References

Please provide the contact details for your two referees - we will then send a form for them to complete.
Please provide the full name and email address for each of your referees:*
How did you hear about us?
Please tell us how you heard about us, for example local YMCA, social media, website*

ALL INFORMATION ON THIS REGISTRATION FORM IS HELD IN THE STRICTEST CONFIDENCE. ANY FALSE STATEMENTS OR FAILURE TO DISCLOSE INFORMATION MAY RESULT IN DISQUALIFICATION.
Please sign*
Date*

MonthDayYear
Date
Use this chance to let us understand your personality, values, and what drives you to be part of this program.

If you are unable to upload your video here, please send it directly to volunteerrecruitment@greenhill-ymca.org
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Should be Empty:

Rows	1 (most like)	2 (neutral)	3 (least like)
High Ropes (requires personal climbing experience)
Outdoor Education & Mountain (experience working with young people preferred)
Water Sports Sports (requires a confident swimmer)

Personal Information

Volunteering programme

Long Term Volunteering Programme (12 months)

Experience

Education

Medical Background

Skills & Motivation

DECLARATION OF CRIMINAL BACKGROUND

References

How did you hear about us?