How Did You Find out About Voluntary Work with Us?

Volunteer Application Form 120 Craven Park Road. London. NW10 8QD Tel: 020 8965 7711 Fax: 020 8453 4519 Email: [email protected]

Title: Name: Address:

Postal Code: Date of Birth: Telephone - Home: Work: Mobile: Email address: Car driver: Y/N Have own car: Y/N

Outline any skills, interests, hobbies, previous experience

How much time do you have available for volunteering? (Please indicate times/days which are convenient for you) Days? Times?

Author: Shafia Begam Rev Date: 2018 年 6 月 2 日 Page No. 1 of 8 Location: AgeUKBrent_Volunteer_Application_Feb AgeUKBrentVolunteerApplicationFeb13 H/C filed: 13.doc Document Name: What volunteering roles are you interested in? Please circle all that apply.

Office Befriending Shop

Advice Driver Other:

Fundraiser Advocacy

Status (Please Tick) Unemployed Student Retired Working Part-Time Working Full-Time Long Term Sick/Disabled Other (please specify)

How did you find out about voluntary work with us? (Please tick any boxes below) Press Advert Leaflet Article in Newspaper Referred by a friend TV/Radio Brent Active Citizens Exhibition From a user of Age UK Brent Poster Talk/Presentation Other (please give details)

What are your reasons for volunteering? (Please tick any of the boxes below)

Author: Shafia Begam Rev Date: 2018 年 6 月 2 日 Page No. 2 of 8 Location: AgeUKBrent_Volunteer_Application_Feb AgeUKBrentVolunteerApplicationFeb13 H/C filed: 13.doc Document Name: To gain work experience To get involved in the community To develop new skills To make new friends To build up my confidence To maintain existing skills Additional reasons or comments

When will you be able to start volunteering?

References

In both the interests of yourself and the people with whom you will be working, we require a reference from two referees who have known you for at least 2 years. These referees MUST NOT BE FAMILY MEMBERS. At least one of them should ideally know you in a professional capacity. If your circumstances mean that you are unable to provide current references, we will be happy to discuss this further with you. 1stReferee Name: 2nd Referee Name: Address: Address:

Postcode: Postcode: Email: Email:

Author: Shafia Begam Rev Date: 2018 年 6 月 2 日 Page No. 3 of 8 Location: AgeUKBrent_Volunteer_Application_Feb AgeUKBrentVolunteerApplicationFeb13 H/C filed: 13.doc Document Name: Tel No: Tel No: Relationship to you: Relationship to you:

As an agency working with vulnerable people, certain volunteer roles are considered exempt from the provisions of the Rehabilitation of Offenders Act 1974 and any convictions must be declared. You must disclose all previous convictions; none of these may be considered spent. Have you ever been convicted, warned, reprimanded or cautioned for a criminal offence, or liable in a civil case? YES/NO If yes, details will be required from you on a separate sheet (in strict confidence). We may require a criminal records check. Do you give your permission for us to carry out a check? YES/NO

Data Protection Act 1998 Information on our database is strictly confidential and we do not pass on any personal data about you to outside organisations and/or individuals without your express personal consent. By completing this form and returning it to us, you are giving us consent to keep your details on record. May we send you updates and more information about Age UK Brent? YES/NO

Emergency Contact: Name: Address:

Author: Shafia Begam Rev Date: 2018 年 6 月 2 日 Page No. 4 of 8 Location: AgeUKBrent_Volunteer_Application_Feb AgeUKBrentVolunteerApplicationFeb13 H/C filed: 13.doc Document Name: Postcode: Tel No: Relationship to you: Has this person agreed to be your emergency contact? YES/NO Do you have any health or ability issues which might effect the volunteering you do?

This information will only be used in deciding what volunteering work you do, not your acceptance or otherwise

I certify that all of the information given on this form is correct

Signature: Date:

Equal Opportunities Policy

Age UK Brent is working towards being an Equal Opportunities organisation. Overall our services are aimed at older people irrespective of gender, race, culture, disability, sexual orientation, politics or religious belief. Some activities may be targeted at particular groups of older people. Age UK Brent has introduced codes of practice on equal opportunities to cover its activities – as a service provider as an employer and in terms of its volunteers – in order to implement its equal opportunities policy. These codes of practice are issued to staff and committee members and are available on request.

Author: Shafia Begam Rev Date: 2018 年 6 月 2 日 Page No. 5 of 8 Location: AgeUKBrent_Volunteer_Application_Feb AgeUKBrentVolunteerApplicationFeb13 H/C filed: 13.doc Document Name: It is the responsibility of all within AUKB to carry out the policy. Day to day administration of the policy includes analysis of monitoring data for staff, volunteers and service users shall be the responsibility of the Chief Officer.

Author: Shafia Begam Rev Date: 2018 年 6 月 2 日 Page No. 6 of 8 Location: AgeUKBrent_Volunteer_Application_Feb AgeUKBrentVolunteerApplicationFeb13 H/C filed: 13.doc Document Name: RECRUITMENT/EQUAL OPPORTUNITIES MONITORING SHEET

As an organisation working towards equal opportunities employment, Age UK Brent wishes to ensure that its recruitment procedures attract suitably qualified/experienced candidates from all sections of the community and of difference backgrounds. The form is designed to assist us assess the effectiveness of other procedures. The information requested below will be separated from your application form and will not be available to the shortlisting/interview panel.

The information from all applicants will be analysed after the appointment has been made in order to help evaluate the recruitment process.

1. Which post are you applying for ? ………………………………………

2. Where did you learn about this vacancy? ……………………………….

3. Age ……………………………………………..

4. Gender (Male/Female) ………………………………

5. Are you registered disabled or could you be if you applied? (Yes/No) ……………

6. Would you describe yourself as (tick box)

Black African Caribbean Other Please specify? ………….. Asian Bangladeshi Indian Pakistani Other Please specify? …………..

Author: Shafia Begam Rev Date: 2018 年 6 月 2 日 Page No. 7 of 8 Location: AgeUKBrent_Volunteer_Application_Feb AgeUKBrentVolunteerApplicationFeb13 H/C filed: 13.doc Document Name: White Irish UK Other Please specify? ………….. Other Please specify? …………..

7. What do you think of this monitoring sheet?

Author: Shafia Begam Rev Date: 2018 年 6 月 2 日 Page No. 8 of 8 Location: AgeUKBrent_Volunteer_Application_Feb AgeUKBrentVolunteerApplicationFeb13 H/C filed: 13.doc Document Name: