<p> Abbey Community Centre  [email protected]  07505 933617 </p><p>Volunteer Application Form</p><p>For the role of: Tech Buddies Volunteer</p><p>First name: ……………………………………… Surname: …………………………………………………….…</p><p>Address (including post code): …………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………… Home telephone number: ………………………….. Mobile number: …………………………………….. Email address: ……………………………………………………………………………………………………………..</p><p>Your occupation: …………………………………………………………………………………………………………..</p><p>Your date of birth: ………………………………………………………………………………………………………..</p><p>______</p><p>How did you hear about the Abbey Community Centre? …………………………………………………..</p><p>Why would you like to volunteer with us? (Please tick all options that apply to you)</p><p> Like the idea of volunteering  Want to get more involved in the community  Make new friends  Have heard that Abbey Community Centre is good to volunteer with  Will help me gain employment  Will help me change my career  Need experience for a course  Other, please state: ………………………………………………………………………………</p><p>Please explain briefly what would you like to gain from your volunteering experience? …………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………</p><p>Volunteer Application Form page 1 of 6 Volunteer Application Form page 2 of 6 What times/days are you available for volunteering? </p><p>Morning Afternoon Evening Days Monday Tuesday Wednesday Thursday Friday Saturday Sunday</p><p>What IT skills and experience do you have? Please give details of software and devices you are particularly familiar with and would like to share your knowledge of with older learners: ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ……………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………..</p><p>Have you done any volunteering before? If so tell us a little about it: …………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………… Please write down 3 words you think best describe the traits needed by a volunteer helping older people with technology. </p><p>1. …………………………………………….. 2. ……………………………………………… 3. ……………………………………………..</p><p>Do you speak any languages besides English? Please list:</p><p>………………………………………………………………………………………………………………………………..…</p><p>Do you have a criminal record or any spent convictions? Yes / No Please give details of convictions …………………………………………………………………………………………………………………………………………………</p><p>Do you have any other support needs we need be aware of? This won’t affect your chance to volunteer with us and will be confidential to Abbey Community Centre staff. (E.g. Dietary requirements, access arrangements, medical conditions:</p><p>Volunteer Application Form page 3 of 6 References</p><p>We require the names and contact details of two people we may approach to give references for you. We cannot accept family members, friends or partners as referees. </p><p>Referee 1:</p><p>Name of Referee: …………………………………………….. Referee job title: …………………………………… </p><p>Company name and address: ……………………………………………………………………………………….</p><p>…………………………………………………………………………………………………………………………… </p><p>Telephone: ………………………………… Email: …………………………………………………………………</p><p>In what capacity do you know the referee? ………………………………………………………………………..</p><p>How long have you known the referee? …………………………………………………………………………...</p><p>Referee 2:</p><p>Name of Referee: ……………………………………………….. Referee job title: …………………………………… </p><p>Company name and address: ……………………………………………………………………………………….</p><p>…………………………………………………………………………………………………………………………… </p><p>Telephone: ………………………………… Email: …………………………………………………………………</p><p>In what capacity do you know the referee? ………………………………………………………………………..</p><p>How long have you known the referee? …………………………………………………………………………...</p><p>Volunteer Application Form page 4 of 6 DBS checks (Disclosure & Barring Service)</p><p>If you will be working with vulnerable adults or children, Abbey Community Centre is required by law to perform a “DBS” (Disclosure and Barring Service) checks. In order to complete the check you will need to show us official identification for you which has your photo on it such as a passport or driving License, national Insurance number and two recent proof of your current address (from two different sources) such as a electricity and phone bill.</p><p>Would you be willing to undergo a (Disclosure and Barring Service) DBS check by ticking this box k </p><p>Your signature: ……………………………………………… Date: ……………………………</p><p>Volunteer Application Form page 5 of 6 Equal opportunities information</p><p>Abbey Community Centre operates a Q4 You are asked to choose the ethnic policy of diversity and equal group that is closest to how you see opportunity in the provision of yourself and specify a more specific services and recruitment. group if you wish.</p><p>It is to assist in the monitoring of this White policy and for that purpose only that we are asking you to provide details ■ White British of your gender, age, any disability ■ White Irish and ethnic origin in this form. All the ■ Any other White background, please information you give will be treated specify in absolute confidence in line with the 1998 Data Protection Act. Mixed</p><p>■ White and Black Caribbean Q1 Your Gender ■ White and Black African ■ White and Asian Male Female ■ Any other Mixed background, please specify</p><p>Q2 Your date of birth: Chinese or other ethnic group</p><p>……………………………………… ■ Chinese ■ Any other group, please specify</p><p>Q3 Disability: Do you consider Asian or Asian British yourself to have a disability e.g. a physical or mental impairment, which ■ Indian has a substantial and long-term ■ Pakistani adverse effect on your ability to carry ■ Bangladeshi out day-to-day activities (please ■ Any other Asian background, please circle) specify</p><p>Yes No Black or Black British ■ Caribbean ■ Somali Your ethnic group : ■ Any other Black African background, Our ethnic background describes how please we think of ourselves. Ethnic specify background is not the same as ■ Any other Black background, please nationality or country of birth. specify</p><p>Volunteer Application Form page 6 of 6</p>