Volunteer Registration Form

Volunteer Registration Form

Thank you so much for being willing to volunteer for us at CLARE CIC - we would love to have you! Please take your time filling in this form and submit when you are ready. Many thanks!
Name*

First NameMiddle NameLast Name
Birth Date*

DayMonthYear
Gender*
Address*

Street Address

Street Address Line 2

CityCounty

Post Code
E-mail*
example@example.com
Mobile Number*

Area CodePhone Number
Phone Number*

Area CodePhone Number
Work Number*

Area CodePhone Number

When are you available?*

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Morning
Afternoon
Evening

Have you volunteered before?*

YesNo
If yes, please detail
Why do you want to Volunteer with CLARE-CIC and what hobbies, interests or training do you have applicable to Volunteering with CLARE CIC? *
Do you have access to a car for use in this role?*

YesNo
Do you consider yourself to have a disability?*

YesNo
Are there any specific adjustments which we need to take into consideration to support you in your Volunteer role? If so, please specify:
Criminal convictions, cautions or bind-overs

Owing to the sensitive nature of our work with “vulnerable groups” CLARE CIC requires all prospective employees to disclose criminal convictions, cautions or bind-overs. Unprejudiced consideration will be given to candidates who disclose cautions, convictions or bind-overs, unless, they are manifestly incompatible with the post in question.
Do you have a criminal conviction, caution or bind-over?*

YesNo
If yes, please give details.
This information will be held in strict confidence in line with General Data Protection Regulations.
Which of the following types of tasks are you willing to help with?
Home Visiting

Social Support At HomeActivity/Arts/Crafts/ReadingCare Of A Pet
Outings

Social ActivityPersonal ShoppingVisit A Relative
Assistance With Appointments

Medical AppointmentsAdvice AppointmentsListening Ear
Events

Event PlanningAssistance at events
Transport

Volunteer DriverOne Off Tasks
Is there any reason why you cannot volunteer in a regulated activity?*

YesNo
CLARE CIC is a registered body with Access NI and adheres to Access NI Code of Practice. We may require an Access NI disclosure check prior to volunteering and a copy of Access NI Code of Practice is available on request
How did you hear about CLARE CIC?*

Volunteer Information EventCommunity Champion LeafletNewspaper or local magazineCLARE WebsiteThrough a Friend or ColleagueSchool/College/UniversityOther

References: Please provide two references excluding family members*

	Reference #1	Reference #2
Name
Relationship
Address Line 1
Address Line 2
City
Postcode
Contact Telephone Number
Email Address

Additional Comments
Date

DayMonthYear
Date
Signature

Clear
Thank you for taking the time to complete this form.

If you have any questions please do not hesitate to email me at j.harrison@clare-cic.org or give me a call at 07513824062 or 028 90 774 185
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Volunteer Registration Form

Which of the following types of tasks are you willing to help with?

CLARE CIC is a registered body with Access NI and adheres to Access NI Code of Practice. We may require an Access NI disclosure check prior to volunteering and a copy of Access NI Code of Practice is available on request

Thank you for taking the time to complete this form.