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.

Date of Birth

Date

Emergency Contact Name

First NameLast Name

Emergency Contact Number

Relationship to you

How did you hear about volunteering at Benenden Hospital

Please tell us what you would like to gain from volunteering with us:

What are you interested in? Please be advised that clinical work is not available through our volunteering programme.

Do you hold a full UK Driving Licence?

Are you registered disabled and therefore do you require any 'reasonable adjustments' to support you in this recruitment process?

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.

Have you at any time received or had a caution or a pending court conviction?

Have you at any time been withdrawn from a volunteering opportunity?

If you have answered yes to the above please provide further details

Signed

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

VOLUNTEER APPLICATION FORM