How would you describe yourself and how do you think others see you?

VOLCARE LONG TERM VOLUNTEER APPLICATION FORM

Surname:Name:

Date of birth: Age Nationality:

Sending organisation in your home country

Occupation:

Address:

Postcode:

Country:Telephone (including international dialling code):

Skype Name (if you have one) ___________________________________________________________

Passport Number (needed for visa)

Place of birth (needed for visa)

E-mail:

Emergency contact Name and telephone number:

When are you available to start this placement?

How many months can you commit to (minimum 8 months)?

Are you willing to work evenings and weekends when required? Yes No

Level of spoken English 1-5 (5 being fluent)

How is your general health?

Do you have any allergies?

What is your height?

What is your build/weight?

Do you have any back or knee problems or other physical problems that would mean that moving and handling people would not be possible? Yes No

Do you have any other special needs? Yes No

(If yes please give details):

Do you have any dietary requirements/restrictions? (please specify

Do you smoke? Yes No

If Yes – are you willing not to smoke during the day when working? Yes No

If No – are you willing to work with people who do smoke? Yes No

Do you drink alcohol? Yes No

If yes around how much do you drink a week?

Do you have any history of recreational drug use or substance dependency? Yes No

NB:VOLUNTEERS SHOULD BE AWARE THAT THE USE OF ILLEGAL DRUGS OR EXCESSIVE ALCOHOL CONSUMPTION WHILST ON PLACEMENT COULD AFFECT CARE TO CLIENTS AND THAT VOLUNTEERS WOULD BE ASKED TO LEAVE VOLCARE.

Do you drive? Yes No

Can you swim? Yes No

Do you cycle? Yes No

Do you like pets i.e. cats and dogs? Yes No

Are you able to cook and willing to cook for others? Yes No

Are there any other factors which we should be aware of i.e. strict religious beliefs or other responsibilities?

Do you have any previous convictions? Yes No

Are you willing to have a police check Yes No

Tell us about yourself and your family background?

PLEASE INCLUDE: Family information – a little bit about your family background. Who you live with? Where you live? Do you have brothers and sisters? etc. How your family feel about you volunteering for 12 months?

How would you describe yourself and how do you think others see you?

Referees: Please read carefully

• Please supply us with the names of two professional referees. These can either be a previous/current employer (someone you have worked for, for at least one year) or a teacher/ professor etc. who has known you for more than one year and who you have had recent contact with. You will need to provide their names, their titles i.e. Manager or Senior Tutor etc, their work/official addresses, email addresses and telephone numbers, and tell us in what capacity they have known you. It is preferable if they speak English as the Manager of Volcare will need to contact them to validate the references.

• Volcare will prioritise applicants who provide this information on the application form. This will enable the Manager of Volcare to assess/decide on your suitability for the volunteering role, as quickly as possible.

1. Name:

Address:

Email:

Phone number:

1. Name:

Address:

Email:

Phone number:

Hobbies and Interests:

Why are you interested in volunteering with Volcare, and what are you hoping to gain from the experience?

Do you have any relevant experience? (If so please detail):

Having read the information about the post, please use the space below to say a few words about what skills and personal characteristics you feel you would bring to the LTV position. Don’t worry if you don’t use all the space provided!

Signed:Date:

Please return this form by fax, post or email along with a short motivation letter to:

Concordia, 19 North Street, Portslade. BN41 1DH.

Tel: 01273 422218, Fax 01273 421182

Date: 2016-04-22; view: 1202