Volunteer Application Form Ref No

Volunteer Application Form ref no:

Personal Details

Title:

Surname: Forename:

Date of Birth: Gender:

Address:

County: Post Code:

Tel: email address:

How did you find out about the Epilepsy Society? (please give details)

Are you legally eligible to volunteer in the UK? Yes/No (European Union residents are eligible. People from outside the EU may require permission to undertake voluntary work. If in doubt, please contact us to ask for further information)

Driving License

Yes No

Do you hold a valid Full UK Driving License?

Yes No

Do you have regular use of a vehicle?

Yes No

Are you 21 or over and would like to be considered as a volunteer driver?

Yes No

If you have any endorsements, please give details:

Yes No

Do you hold a license with category D1 approval? It is optional to answer questions relating to driving/use of vehicle and need only be answered if you would like to undertake our driving courses to support trips away from the centre

Education

GCSE Subject: Maths Grade:

Subject: English Grade: Year:

Diploma or NVQ Subject: Level: Year:

Subject: Level : Year:

Degree Subject: Grade: Year:

References Please list two references.(one being your current employer, teacher or tutor) Full Name: Relationship: Company: Phone: Address:

Full Name: Relationship: Company: Phone: Address:

YES NO May we contact your referees prior to interview? Please give a summary of your Career History

Please answer the following questions. Additional information

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature: Date: Please return form to: Martina Pettit – Volunteer & Projects Coordinator Epilepsy Society Chesham Lane Chalfont St Peter SL9 0RJ Or electronically to; [email protected]