Volunteer Application Form

Section 1 of 2

Please complete this form so that we can find out a little more about you. All personal information you provide is held securely by Embracing Age. We respect your privacy and do not pass you data on to other organisations. You can read our privacy notice by clicking on the link in the footer of our website. PLEASE NOTE THAT THIS FORM NEEDS TO BE SUBMITTED IN ONE SITTING - THERE IS NO FACILITY TO SAVE AND COME BACK TO LATER.

Which role are you applying for?* —Please choose an option—CardsBefriendingAdminGardeningSocial MediaSensory Dementia Volunteer First name* Last name* Email* We need this so that we can communicate with you about volunteering. Phone number* We need this to contact you about volunteering. First line of address* Second line of address (optional) Town* Postcode* Area* —Please choose an option—London Borough of Richmond upon ThamesIsle of Wight Date of birth* Status* —Please choose an option—UnemployedStudentRetiredWorking part timeWorking full-timeLong term sick or disabled Tell us about yourself and your relevant* Outline any skills, interests, hobbies, previous experience you have gained in the last 10 years. Tell us about what motivates you to volunteer* How much time do you have available for volunteering?* How long do you hope to volunteer for?* —Please choose an option—3 months6 monthsA year or longer How did you find out about volunteering for Embracing Age? —Please choose an option—Do it websiteEmbracing Age websiteRichmond CVSIsle of Wight Volunteer CentreOther... Your Health* In order that we may offer you appropriate support in your volunteer role, please advise us of any health problems, disability or medical condition that you think may affect your volunteering.

Section 2 of 2: References

In both the interests of yourself and of the people with whom you will be working, we require a reference from TWO referees who have known you for at least two years. These referees MUST NOT be family members. They must be over 18 years old.

Name of first referee* First and last name. Address of first referee Email of first referee* Telephone number of first referee In what capacity has this referee known you and for how long?* Name of second referee* First and last name. Address of second referee Email of second referee* Telephone number of second referee In what capacity has this referee known you and for how long?* Working with vulnerable adults* As an agency working with vulnerable adults we have a duty of care towards our clients. We are required to carry out a DBS check on some of our volunteers for this reason, depending on your role. Please indicate if you are happy for this to take place. —Please choose an option—YesNo Declaration* By entering your initials in the box below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge. (*) Mandatory field