<p> VOLUNTEER WAREHOUSE ASSISTANT DETAILS FORM Please complete this application form. Information will be treated in the strictest confidence. </p><p>PERSONAL DETAILS Title: Date of Birth:</p><p>Surname:</p><p>First Name(s):</p><p>Address:</p><p>Postcode:</p><p>Home tel no:</p><p>Mobile tel no:</p><p>E-mail address:</p><p>WHEN ARE YOU AVAILABLE TO HELP? Please tick to indicate when you are available to volunteer. Wednesday Morning Afternoon</p><p>Friday Morning Afternoon</p><p>LOCATION OF VOLUNTARY ROLE</p><p>Hope House Retail Warehouse, Unit 11, Whitegates Industrial Estate, Wrexham LL13 8UG RELEVANT EMPLOYMENT OR VOLUNTEERING EXPERIENCE If you have any relevant employment and volunteering experience, please tell us about it including the name of the organisation, a brief description of what you did there and an indication of when the role started and ended:</p><p>YOUR SKILLS AND INTERESTS We will try and use your skills, experience and special interests, if they are relevant. Please tell us what they are- this can include relevant skills, knowledge, interests, voluntary activities and training. (Please continue on an additional sheet if necessary)</p><p>REFERENCE Please give the details of a person who has agreed to supply a reference. Title/name: Relationship to you:</p><p>Address:</p><p>Postcode: Tel. no: E-mail: EMERGENCY CONTACT Please provide details of someone we could contact in case of an emergency while you are volunteering Name</p><p>Contact details </p><p>Telephone number (Essential) Relationship to you</p><p>OTHER INFORMATION Are you related to a Board Member or employee of Hope House Children’s Hospices? If yes, please tell us their name and relationship to you: Yes/No</p><p>Are you related to a service user or past service user of Hope House Children’s Hospices? If yes, please tell us their name and relationship to you : Yes/No</p><p>This volunteer role will involve standing for prolonged periods and some lifting. Please tell us if you need us to make any changes to enable you to volunteer: </p><p>DECLARATION DATA PROTECTION ACT 1998 I declare that the information on this form is true When you sign and return this form you consent to and complete. I understand that if it is found that Hope House Children’s Hospices keeping and using any statement is false or misleading, Hope the information on it for purposes relating to your House Children’s Hospices may stop my volunteering. If you start this role, this data will be volunteering role. kept as part of your volunteer record. No personal information will be passed to anyone else without asking you first. If you leave your role (or don’t start) all data we hold about you will be destroyed. Signature Date</p><p>Please return the completed form to Shirley McCann at the Wrexham Shop or post to: The Volunteering Department, Hope House Children’s Hospices, Nant Lane, Morda, Oswestry, SY10 9BX</p>