<p>London Borough of Havering Early Help Volunteer Registration Form Please note that all information given on this form is treated and stored as confidential. We ask you to provide these details to assess your suitability as a volunteer and for statistical purposes Full Name</p><p>Address</p><p>Telephone</p><p>Email</p><p>Date of birth</p><p>Please select the right option for you:</p><p>Gender Male Female</p><p>Ethnic Group White British White Other Mixed Heritage Asian British Asian Other Black British Black Other Other (please specify):</p><p>Employment Employed full time Employed part time Self-employed Status Student Retired Unemployed Unable to work</p><p>Do you consider Yes (please specify): No yourself to have a disability or any additional needs?</p><p>Previous conviction declaration (to be used in conjunction with this application form):</p><p>The legislation that allows us to ask for this is the Rehabilitation of Offenders Act 1974 (exceptions order 1975). This means that you must answer the question below, telling us about all your convictions, even those that are spent. Information about criminal convictions is requested to assist the selection process and will be taken into account only when the conviction is considered relevant to the role.</p><p>You will also be required to undertake a Disclosure & Barring Service (DBS) Check. In signing this form, you are giving consent to this.</p><p>Have you ever been convicted of any criminal offences? Yes If yes, please provide details of specific convictions and dates:</p><p>Are you currently engaging with any children’s or young people’s Yes services?</p><p>Please email this registration form to [email protected] London Borough of Havering Early Help Volunteer Registration Form Please note that all information given on this form is treated and stored as confidential. We ask you to provide these details to assess your suitability as a volunteer and for statistical purposes If yes, please provide details including dates and nature of engagement:</p><p>Are you happy for us to check Early Help records in terms of the Yes support you accessed?</p><p>References – please provide us with two references that have known you for at least two years (one professional/educational and one personal but not a family member)</p><p>Name: Name:</p><p>Relationship to you: Relationship to you:</p><p>Telephone: Telephone:</p><p>Email: Email:</p><p>What are you hoping to get out To give something back to the To make a difference to someone of volunteering? (Please circle community all that apply) To increases chances of To get into my preferred career employment To learn new skills To meet new people</p><p>Please email this registration form to [email protected] London Borough of Havering Early Help Volunteer Registration Form Please note that all information given on this form is treated and stored as confidential. We ask you to provide these details to assess your suitability as a volunteer and for statistical purposes In bullet points, please tell us why you are interested in volunteering with the Early Help Service, including any relevant experience and qualifications: </p><p>Consent to Share Information Consent Statement for Information Storage and Information Sharing</p><p>“We need to collect the information contained within this document so that we can assess your suitability as an Early Help volunteer and also for statistical purposes. We will store your information in accordance with the Data Protection Act 1998 and ensure that it is accurate, used in a way that is relevant, kept safe and secure, not kept for longer than is necessary, and handled according to your rights.”</p><p>“We will treat your information as confidential and we will not share it for any other reason unless we are required by law to share it or unless you will come to some harm if we do not share it. In any case we will only ever share the minimum information we need to share”</p><p>I understand the information that is recorded on this form and that it will be stored and used for the purposes stated only. I have had the reasons for information sharing and information storage explained to me and I understand those reasons. YES NO</p><p>Signature:</p><p>Print name:</p><p>Date:</p><p>Please email this registration form to [email protected]</p>