Volunteer Application Form

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Mobile Phone Number

Area CodePhone Number

Email

example@example.com

Date of Birth

Date

Please give information about your experience of parenting or any contact you may have had with children and families. E.g.What did/do you find enjoyable or challenging about parenting/parenting experience?

Please give details of any information that may support your application. Include any relevant skills, interests, past employment/voluntary work

REFERENCES: Please give the name and address of two referees that you have known for a minimum of two years (not a relative) include at least one professional reference, (previous employer wherever possible; alternatively, school, college or other professional such as a religious leader or a volunteer supervisor) who may be contacted by Home-Start.

Please ask permission prior to submitting referees details and confirm full address.

Reference 1 - Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Email

example@example.com

Time known this person and in what capacity

Reference 2 - Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Email

example@example.com

Time known this person and in what capacity

The minimum time commitment we ask of volunteers is 2- 3hours per week on a regular basis for at least one year with occasional additional time for training and support/supervision, is this manageable?

As volunteers are in a privileged position visiting families in their own homes and have contact with young children, Home-Start has a responsibility to ensure that no one becomes a volunteer who would misuse this trust. Therefore, it is essential that you complete and sign this form.

Haveyou had any personal contact with Social Services/Social Work Department or NSPCC in connection with children in your care? Have any of your children been subject to a child protection, child inneed plan or assessment?

Do you consider yourself to have a disability or health condition and if so what adjustments could Home-Start provide to enable you to volunteer?

Have you ever been dismissed from any paid or voluntary work?

Haveyou ever been arrested or had contact (e.g. received a warning/caution/attended court) with the police for any type of criminal offence?

Are there any matters outstanding which may lead to a criminal prosecution?

If you answer yes to any question please give details:

If you do not declare existing or spent cautions or convictions you may not be selected. However, if you declare any of the above it may still be possible to become a volunteer

I know of no reason why I would be unsuitable to be a Home-Start volunteer. I will report any changes in my circumstances which may affect my role

Where did you hear about Home-Start in East Lancashire

I give permission for Home-Start East Lancashire, to carry out checks e.g. DBS at enhanced level or other checks with the appropriate agency. I understand that failing to declare my involvement no matter how minor, with the Police/ Criminal Justice system may result in my being deemed unsuitable as a volunteer. I understand that my national insurance number will be required and that personal information about me will be held in records (including electronic records) some of which may be sensitive information such as age, race, gender, disability and that this information may be used for monitoring purposes. I agree to the scheme holding this information and understand that I may ask to see my records at any time.