<p>Volunteer Application Form ref no: </p><p>Personal Details</p><p>Title: </p><p>Surname: Forename:</p><p>Date of Birth: Gender: </p><p>Address:</p><p>Town:</p><p>County: Post Code:</p><p>Tel: email address: </p><p>How did you find out about the Epilepsy Society? (please give details) </p><p>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)</p><p>Driving License</p><p>Yes No </p><p>Do you hold a valid Full UK Driving License?</p><p>Yes No </p><p>Do you have regular use of a vehicle?</p><p>Yes No </p><p>Are you 21 or over and would like to be considered as a volunteer driver?</p><p>Yes No </p><p>If you have any endorsements, please give details: </p><p>Yes No </p><p>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</p><p>Education</p><p>GCSE Subject: Maths Grade: </p><p>Subject: English Grade: Year:</p><p>Diploma or NVQ Subject: Level: Year:</p><p>Subject: Level : Year:</p><p>Degree Subject: Grade: Year:</p><p>References Please list two references.(one being your current employer, teacher or tutor) Full Name: Relationship: Company: Phone: Address:</p><p>Full Name: Relationship: Company: Phone: Address:</p><p>YES NO May we contact your referees prior to interview? Please give a summary of your Career History</p><p>Please answer the following questions. Additional information</p><p>Disclaimer and Signature</p><p>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.</p><p>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]</p>