<p> Volunteer Application Form</p><p>Surname: Forename(s):</p><p>Current address:</p><p>Day time telephone no: Evening telephone no: Mobile telephone no: Email address: Volunteer Role applied for and location:</p><p>Education and Training</p><p>Please give details of any education, or professional qualifications which might be applicable to your chosen volunteer role, or any other relevant qualifications, training or courses attended</p><p>Present Occupation (please tick as appropriate) Employed Student Non-employed (not seeking paid work) Jobseeker / Employment Support Allowance (please specify) Please note that if you are on any kind of benefits you must notify your Job Centre / Local Council (Housing Benefit) prior to commencement of volunteering</p><p>Page 1 of 5 VOLA - February 2017 Volunteer Application Form</p><p>Retired Other (please specify)</p><p>Please give a brief summary of your previous employment</p><p>Have you ever volunteered before? (Give details)</p><p>What do you hope to gain from the volunteer experience?</p><p>What are your hobbies and interests?</p><p>If you are applying to be a Volunteer Counsellor, please give details of your relevant qualifications below:</p><p>Page 2 of 5 VOLA - February 2017 Volunteer Application Form</p><p>Please note you will be expected to provide copies of all relevant qualifications, BACP membership and proof of public liability insurance prior to Induction.</p><p>Other details Do you have a full driving licence? Yes No Do you have any current endorsements? Yes No Do you have use of a car? Yes No Please note that if you use your car for the purposes of your volunteering role you may need to insure your car for Business purposes, please check with your insurer. Do you know anyone who currently works for Open Road? Where did you hear about this Open Road opportunity?</p><p>Convictions</p><p>Have you ever been convicted of a criminal offence? Yes No</p><p>If ‘yes’ please give details of any unspent convictions. Spent convictions do not have to be declared as the job is not one covered by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975.</p><p>An enhanced DBS check will be required, however DBS disclosures will be viewed on a case by case basis.</p><p>Page 3 of 5 VOLA - February 2017 Volunteer Application Form</p><p>References Please give details of two referees. Due to the nature of the service we provide we require one personal reference and one professional reference. The professional reference can be from an employer, former employer, colleague, ex colleague, a professional (e.g. Social Worker, Probation Officer, GP, Solicitor, Religious Representative, or Teacher), or anyone who has known you in a professional capacity. The personal reference can be from a friend but not a family member.</p><p>1. Name: 2. Name:</p><p>Address / Email Address / Email</p><p>Telephone number: Telephone number: Occupation: Occupation: Time known: Time known:</p><p>I give / do not give permission to take up my I give / do not give permission to take up my reference prior to an initial informal interview being reference prior to an initial informal interview being undertaken (delete clearly as appropriate) undertaken (delete clearly as appropriate)</p><p>Page 4 of 5 VOLA - February 2017 Volunteer Application Form</p><p>Data protection - Information from this application may be processed for purposes registered by the Employer under the Data Protection Act 1998. Individuals have, on written request [on payment of a fee] the right of access to personal data held about them. I hereby give my consent to Open Road processing the data supplied in this application form for the purpose of volunteer recruitment. Declaration - I declare that the information given in this application is to the best of my knowledge complete and correct. Signature:</p><p>Please now complete the Equal Opportunities Monitoring Form on the next page. Please email your application to [email protected] Alternatively, post your application to: The HR Volunteering Team, Open Road, 12 North Hill, Colchester, CO1 1DZ</p><p>Thank you for your application and for your interest in Open Road.</p><p>Page 5 of 5 VOLA - February 2017</p>