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Outreach Volunteer Form

ADVICE OUTREACH VOLUNTEER PROGRAMME
APPLICATION FORM

 

Confidential

Personal Details:
Title:
First Name:
Surname:
Address:
County:
Postcode:
Contact Tel :
Mobile:
E-mail:
DOB:

Education & Qualifications

Dates
Place of Study
Subjects Taken / Grades Achieved
16/08/2000 BIFHE A'Level Art (C+)


Are You (please tick):

Other (please state)

Previous Work Experience:

Please briefly outline any previous work experience:
Dates
Employer
Your Role (please include your job Title)

 


Have you previously been involved in voluntary work?
Yes No
If yes, please give details:


What area of voluntary work are you most interested in? (please tick)


How much time can you commit to voluntary work: (please tick)

MON

TUE

WED

THURS

FRI

SAT

SUN

MORNING

AFTERNOON



Why do you want to do voluntary work?



Why have you applied to Gingerbread as a volunteer?



Disability

The Disability Discrimination Act (NI) 1995 describes disability as "someone with a physical or mental impairment which has a substantial and long-term adverse effect on his/her ability to carry out normal day-to-day activities"(S1 and Sch1).  It also covers people who have had a disability within the definition and since recovered. Having read the above definition, do you consider yourself to be or have been disabled?   
Yes No

If yes, please give details:



Hobbies / Interests:

What hobbies, interests or spare-time activities do you enjoy?

 

Please state any other relevant information, which you might like to make in support of your application:



Due to the nature of our work, we need to ask if you have been convicted of any criminal offence/s?
Cautions or Bind-Over Orders?
Yes No

If yes, please give details:

 
DECLARATION: I declare that the information given above is true and accurate. Yes
 

References:

Please provide names and addresses of two people, not related to you, who we may contact for a reference?

Reference 1:
Title:
Name:
Address:
County:
Postcode:
Contact Tel :
Mobile:
E-mail:

Reference 2:
Title:
Name:
Address:
County:
Postcode:
Contact Tel :
Mobile:
E-mail: