Befriender Sign-Up Form
Please fill out this form to register as a befriender and help others.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
-
Month
-
Day
Year
Date
Age
Languages Spoken
Standard of Education
High School
University / College
Degree
Car Details (For volunteer safety) enter Car Make, Colour and Registration if applicable
Days and times you are available
*
Your interests or hobbies
Tell us a bit about yourself and why you want to be a befriender
*
Skills or Strengths
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Reference 1 Name (Please have their consent)
*
First Name
Last Name
Reference 1 Job Description
*
Reference 1 Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reference 1 Email Address
*
example@example.com
Reference 2 Name
First Name
Last Name
Reference 2 Job Description
Reference 2 Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Reference 2 Email Address (Please have their consent)
example@example.com
Do you do any other volunteering work?
Where did you hear about us?
Dependent upon the role you are applying for, some roles are exempt from the provision of the Rehabilitation of Offenders Act 1974. This means applicants are not entitled to withhold information about convictions, which for other purposes are "spent" under the provisions of the Act. You should therefore declare if you have ever received a caution, reprimand or warning. Please note, having a criminal conviction will NOT necessarily prevent you from volunteering with Neshomo.
Do you have any convictions, cautions, reprimands or warnings as defined by the Rehabilitation of Offenders Act 1974?
*
Yes
No
I give consent for Neshomo to use an image of myself for the ID Badge.
*
Yes
No
Signature
*
Thank you for completing the Neshomo Befriender application, a supervisor will be in touch!
Sign Up
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