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.
Home Phone Number
Please enter a valid phone number.
Date of Birth*

DayMonthYear
Date
Emergency Contact Name*

First NameLast Name
Emergency Contact Number*
Relationship to you*
How did you hear about volunteering at Benenden Hospital*
My reasons for getting involved. Please tell us what you would like to gain from volunteering with us:*

Boost confidenceWork ExperienceImprove career prospectsNew challengesGive back/ feel helpfulShare skillsMeet new peopleFill spare time
Types of volunteering roles available. What are you interested in? Please be advised that clinical work is not available through our volunteering programme.*

Reception ServicesMeet and GreetPortersCateringClinical SupportGrounds and EstatesHealth Records/ Clinical AdminAdministration - Finance, Marketing etc.
Your Availability
I have a full driving licence *

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

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

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Have you at any time been withdrawn from a volunteering opportunity?*

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.

FOR APPLICATIONS TO VOLUNTEER AT BENENDEN HOSPITAL

Claire Mansfield

Benenden Hospital

Goddard's Green Road

Benenden

Cranbrook

Kent

TN17 4AX
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VOLUNTEER APPLICATION FORM