<p> Thank you for expressing an interest in volunteering with Simon Community Northern Ireland. We will acknowledge your application form on receipt. Our Volunteer Coordinator will be in touch with you. We look forward to hearing from you.</p><p>Please keep the coversheet attached to your application.</p><p>SECTION ONE: Personal Details (Please Complete Using Block Capitals And Black Ink)</p><p>Full Name</p><p>Address Postcode</p><p>Contact Email Number</p><p>SECTION TWO: Volunteering With Simon Community Ni</p><p>When would you be available to volunteer with us? (Please advise us of any specific times that would suit you).</p><p>24th December 25th December </p><p>Activities Leader</p><p>Kitchen Assistant</p><p>Preferred Belfast Larne Lisburn location</p><p>SECTION THREE: Please tell us what you hope to gain through volunteering with us. </p><p>Please tell us what motivated you to volunteer with Simon Community NI</p><p>Please tell us about any relevant experience, skills or interests that you could bring to the role.</p><p>ChristmasVolApp Version I Nov 2017 SECTION FOUR: Support Needs</p><p>Are there any reasonable adjustments that we could make that would enable you to enjoy equality of opportunity in seeking a volunteer role with us?</p><p>SECTION FIVE: References </p><p>Please provide details of two referees. Where possible, one of these should be your current/ most recent employer or a University tutor. If these are not available, please contact our Volunteer Coordinator to discuss alternatives. Your referees should be in a position to assess your skill and knowledge in relation to the volunteering role you are applying for </p><p>REFEREE 1 REFEREE 2 </p><p>NAME NAME</p><p>OCCUPATION OCCUPATION </p><p>ADDRESS ADDRESS</p><p>POSTCODE POSTCODE</p><p>TEL NO TEL NO</p><p>EMAIL EMAIL</p><p>SECTION SIX: Disclosure </p><p>ChristmasVolApp Version I Nov 2017 Please note that convictions do not necessarily debar an individual from obtaining a volunteering position. </p><p>Have you ever been convicted of a criminal offence, which cannot be considered ‘spent’ under the Rehabilitation of Offenders Act (NI) Order 1978, amended in 2014? </p><p>If yes, please provide details: </p><p>SECTION SEVEN: Data Protection </p><p>At Simon Community NI, we value your support and promise to respect your privacy. Any information you provide will be held and managed in accordance with the Data Protection Act (1998). We will not disclose, or share, any personal information provided by you with any third party organisation without your consent. </p><p>The information provided on this form will be used in the recruitment and selection of volunteers and may be disclosed to all those who need to see it. It will also form the basis of a confidential volunteer. </p><p>We would like to keep you informed about the vital work we do and of further volunteering opportunities that you may be interested in. If you do not wish to receive this information, please tick this box. </p><p>SECTION EIGHT: Declaration </p><p>Signature Date</p><p>ChristmasVolApp Version I Nov 2017</p>