VOLUNTEER Application Form

VOLUNTEER APPLICATION FORM
Title (Mr/Mrs/Miss/Ms/Other):*
Forename(s):*
Surname:*
Address*

Street Address

Street Address Line 2

CityCounty

Post Code
Email Address*
example@example.com
Mobile Number*
Please enter a valid mobile phone number.Format: 00000 000000.
Home Phone Number
Please enter a valid phone number.Format: 00000 000000.
Emergency Contact Name*

First NameLast Name
Emergency Contact Number*
Relationship to you*
How did you hear about volunteering at Benenden Hospital*
Boost confidenceWork ExperienceImprove career prospectsNew challengesGive back/ feel helpfulShare skillsMeet new peopleFill spare time
Reception ServicesMeet and GreetPortersCateringClinical SupportGrounds and EstatesHealth Records/ Clinical AdminAdministration - Finance, Marketing etc.
YesNo
Please provide more information:
Any accessibility requirements, sign language interpreter, etc.
DECLARATION

Please be advised that all eligible volunteers will be subject to a Disclosure and Barring Service (DBS) check and references. The cost of the DBS check will be borne by the Hospital.

You are therefore required to declare whether you have any criminal convictions, spent or unspent. Your declaration will be treated in the strictest confidence.
YesNo
YesNo
If you have answered yes to the above please provide further details
Signed*

Clear
All information contained in this form and any attachments will be treated in the strictest confidence and will be retained under the Data Protection Act 1988.

If you would like further information regarding volunterring at Benenden Hospital, please contact Debbie Paddington on debbie.paddington@benenden.org.uk
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VOLUNTEER APPLICATION FORM