DEBRA VOLUNTEER APPLICATION FORM

DEBRA is the national charity that supports individuals and families affected by Epidermolysis Bullosa (EB) – a painful genetic skin blistering condition which, in the worst cases, can be fatal.
VOLUNTEER APPLICATION FORM

Thank you for your interest in volunteering with DEBRA. Please take a few minutes to tell us about yourself and we'll be in touch to help you get started. If you require help completing this form, please contact us on 01698 424210
Full Name*

TitleFirst NameLast Name
Address*

Street Address

Street Address Line 2

CityCounty

PostcodeCountry
phone number*
E-mail
Birth Date

MonthDayYear
What sort of role are you interested in? *
If you are interested in a specific role - a particular aspect of shop work, for example - or have specific skills that you'd like to offer, please let us know:
How did you hear about volunteering for DEBRA?
Please explain why you would like to volunteer for DEBRA and tell us a little bit about your skills and interests
Monday amTuesday pmThursday amFriday pmMonday pmWednesday amThursday pmSaturday amTuesday amWednesday pmFriday amSaturday pm
If you are applying to volunteer in one of our shops, please indicate which one you are interested in.
Emergency contact details*
Please provide the names and email addresses of two people (not relatives) who can vouch for your honesty and integrity
Please note that your referees can be friends, teachers, colleagues, heath care providers; anyone who knows you well and is not related to you.
Referee name (1)*

First NameLast Name
Referee email (1)*
Referee name (2)*

First NameLast Name
Referee email (2)*
If you have any criminal convictions which are not yet spent under the terms of the Rehabilitation of Offenders Act 1974 (or which are currently pending), please provide details:
All information will be treated in the strictest confidence. Please note that prior or pending criminal convictions may not prevent you from volunteering with DEBRA, but failure to disclose relevant information will result in immediate dismissal.
DEBRA fully complies with the Data Protection Act 1998. We respect your privacy and will not pass your details on to any third party. We would like to keep you updated on our work. If you would rather not be contacted, other than regarding your volunteer role, please tick this boxI would be happy to be contacted by email
I certify that to the best of my knowledge, the information I have provided on this form is true and accurate and not misleading in any way. I consent to this information being stored on a manual or electronic filing system in line with Data Protection legislation.I confirm that I am over 16 years of age
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