Indicates required field We ask all our volunteers to complete this application form. It asks for your basic contact information and a little background information on what you’d like to get out of volunteering for us. We take the security of your information seriously. Your response will be stored and used by Healthwatch Cornwall in line with our privacy policy. Personal details Full Name Title Title - Select -MissMsMrMrsDrOther… Enter other… First Middle Last Address Address Address 2 City/Town Postal Code Email Mobile number Home number We will usually contact you via email unless you notify us otherwise. When you join us as a volunteer, your email address will be added to our mailing list for the Healthwatch Cornwall newsletter and our volunteer specific newsletter. These are one of the main ways we communicate updates, news and volunteering information - if you wish to opt out from the mailing list please let us know. Volunteer Role Please provide information below about the volunteer role you are applying for, and why you want to volunteer with Healthwatch Cornwall. This can include, what you hope to get from your experience with us as well as any relevant voluntary or paid experience, or any qualifications, hobbies or interests that you have had that you feel would help you undertake the role that you are applying for. Please let us know which role you would like to apply for - Select -Community Engagement and Outreach VolunteerCommunity Promoter VolunteerImpact VolunteerYouth Volunteer Please explain why you'd like to volunteer with Healthwatch Cornwall? About text formats Have you volunteered before? About text formats Please explain and include organisation and role. What other skills or interests do you have that maybe useful to know? About text formats For example, other languages spoken, design skills Where did you find out about our volunteer opportunities? About text formats Availability Certain volunteering opportunities are dictated by scheduled events and days our staff work. Please note the role descriptions may mention a minimum commitment per week. When would you be able to volunteer with us? Please provide the times you are available. Monday am Monday pm Tuesday am Tuesday pm Wednesday am Wednesday pm Thursday am Thursday pm Friday am Friday pm We may have community events on a Saturday or Sunday. Would you be willing to volunteer on a weekend? All of the above Do you hold a current driving licence? Yes No Do you have your own transport? Yes No Do you have any particular needs that we should be aware of so we can support your volunteering with us? For example, induction loop, wheelchair access. Supporting Information Please provide us with the names of two people to provide a reference. For some roles we will only contact one referee e.g., office-based volunteering. Referees must be over the age of 18 and must not be related to you. These can be previous employers, college or university tutor, personal acquaintances or anyone else who can comment on your suitability for the volunteer role. Referees should have known you for at least two years. First Referee Full Name Title Title - Select -MissMsMrMrsDrOther… Enter other… First Middle Last Address Address Address 2 City/Town Postal Code Email Main phone number: How do you know this person? Second Referee Full Name Title Title - Select -MissMsMrMrsDrOther… Enter other… First Middle Last Address Address Address 2 City/Town Postal Code Email How do you know this person? Declarations Are you willing to undertake a DBS check when necessary? Yes No As your role may involve you working with young people and vulnerable adults we may require you to complete a disclosure and barring service (DBS) disclosure. Declaration of convictions Some of Healthwatch Cornwall’s volunteering opportunities may involve direct contact with potentially vulnerable members of the public. These roles are exempt from the Rehabilitation of Offenders Act 1974 (amended). This means that if you are applying for a role which will involve contact with vulnerable people you will be required to declare your entire criminal record including cautions, reprimands, final warnings and criminal convictions categorised as spent under the above legislation. This information will only be disclosed to specific Healthwatch Cornwall staff. Have you been convicted of a criminal offence (other than ‘spent’ convictions under the Rehabilitation of offenders Act 1974) Yes No If Yes, please provide details: (this may not prevent you from volunteering with us) Data Protection As part of the volunteer recruitment procedure, we will collect and store sensitive personal data about you. We are required by law to obtain your consent to such data being recorded. It is our policy to store data relating to the volunteer recruitment procedures for a minimum of 12 months after the date on which it is submitted. Any information of this nature will be treated confidentially. Sensitive personal data is defined as information relating to any of the following; racial or ethnic origin, political opinions, religious beliefs, trade union membership, health, sexuality or sex life, offenses and/or convictions. For the purposes of the Data Protection Act 1998, the Data Controller is Anna Pascoe – Chair of Healthwatch Cornwall. I declare that the information in this application form is correct to the best of my knowledge and acknowledge that by signing this form I give my consent to sensitive personal information being recorded and stored securely by Healthwatch Cornwall. Reset Sign above CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Submit Leave this field blank
