Volunteer Warehouse Assistant Details Form

VOLUNTEER WAREHOUSE ASSISTANT DETAILS FORM

Please complete this application form. Information will be treated in the strictest confidence.

PERSONAL DETAILS
Title: / Date of Birth:
Surname:
First Name(s):
Address:
Postcode:
Home tel no:
Mobile tel no:
E-mail address:
WHEN ARE YOU AVAILABLE TO HELP?
Please tick to indicate when you are available to volunteer.
Wednesday / Morning / Afternoon
Friday / Morning / Afternoon
LOCATION OF VOLUNTARY ROLE
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 itincluding the name of the organisation, a brief description of what you did there and an indication of when the role started and ended:
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)
REFERENCE
Please give the details of a person who has agreed to supply a reference.
Title/name: / Relationship to you:
Address:
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
Contact details
Telephone number(Essential)
Relationship to you
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
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
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:
DECLARATION / DATA PROTECTION ACT 1998
I declare that the information on this form is true and complete. I understand that if it is found that any statement is false or misleading, Hope House Children’s Hospices may stop my volunteering role. / When you sign and return this form you consent to Hope House Children’s Hospices keeping and using the information on it for purposes relating to your volunteering. If you start this role, this data will be 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

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