Personal details

Surname*

Forename (s)*

Address line 1*

Address line 2

Town*

Postcode*

Landline Phone Number

Mobile Telephone Number

Email Address

Date of Birth*

Who should we contact in the case of an emergency?

Emergency Contact number

Name and relation of Emergency Contact

Name of GP Practice and Practices contact number*

Monitoring
We aim to involve people from a range of backgrounds and it is important that we monitor whether we are achieving this. In addition, we have to provide anonymous, statistical information to our funders.
If you consent to us recording this information for statistical and research purposes, please answer the following questions:

Gender

Ethnic Group

Employment Status

Do you consider yourself to have a disability or impairment and is there anything we need to be aware of in order to support/enable you to volunteer with us?

Volunteer Details

what sort of volunteering opportunity are you interested in?

What is your availability for volunteering? What geographical areas are you willing to support in (e.g Exeter, East Devon, Mid Devon, North Devon)*

Please tell us about any interests, skills, hobbies or experience which you feel may be relevant.

What would you like to achieve through your volunteering role? Select all that apply

To develop an interest

Yes

To give back to the community

Yes

To increase my employability

Yes

To meet people/make new friends

Yes

To increase my confidence and self-esteem

Yes

To fill spare time

Yes

to help with my rehabilitation

Yes

To use my skills and experience

Yes

To learn new skills

Yes

To get more involved in community

Yes

Other

References
Because you may come in to contact with people who are particularly vulnerable, we ask you to give the names of two referees. Referees should be someone who knows you well but is not related to you. It should be someone who can tell us what sort of person you are and about your suitability as a volunteer. Ideally you will have known them for more than two years. One of them needs to be somebody who knows you in a professional capacity (eg. employer, GP, college tutor, social worker)

Reference 1
Please provide Referee’s name, email or postal address and state how long you’ve known the person and in what capacity*

Reference 2
Please provide Referee’s name, email or postal address and state how long you’ve known the person and in what capacity*

We would like to send communications out in regards to volunteering news updates, training information, details about events and requests for help. How would you prefer communications?

Would you be happy for Westbank to promote other activities and services that we think might be of interest to you?*

Criminal Convictions: Because of the nature of our work, you are required by the Rehabilitation of Offenders Act 1974 to declare all unspent criminal convictions, cautions, reprimands or warnings. Please detail below:
(Having a police record does not necessarily mean that you cannot do voluntary work. However, in order to seek voluntary opportunities with this organisation it is essential that you declare any convictions).

Criminal Convictions