SAH Volunteer Application Form - St Ann's Hospice

Volunteer Application FormThe information you give on this application form will allow us to assess your suitability for voluntary workat St Ann’s Hospice and will enable us to match your skills, experience and availability to our currentvacancies.Please complete all sections using BLOCK CAPITALS. All details will be treated as strictly confidentialand will be held by our Volunteer Services Department and not disclosed to any other party without yourconsent.St Ann’s Hospice operates across a number of sites. Please indicate which hospice site you wish tovolunteer your time at:Heald Green Little Hulton Neil CliffeCentre Shops No preference Please Return Completed Application Form To:For Heald Green site, the Neil Cliffe Centre and ourcharity shops:St Ann’s Hospice,St Ann’s Road North,Heald Green,Cheadle,Cheshire SK8 3SZFor our Little Hulton hospice site:St Ann’s Hospice,Peel Lane,Little Hulton,Worsley,Manchester M28 0FEHow did you find out about volunteering opportunities at St Ann’s Hospice?Personal detailsTitle: Forename(s): Surname: Date of birth:Address:Home telephone:Mobile telephone:Postcode:Email address:Emergency contact detailsName:Home telephone:Relationship to you:Mobile telephone:

Areas of interestPlease tick the area(s) you are interested in. We will always try to find a suitable vacancy that fits youravailability and skills, however please be aware that a vacancy may not always be available in your area ofinterest.For further information on each area of hospice volunteering, please see the enclosed sheet ‘VolunteeringOpportunities’.Admin/clericalworkBereavementsupport Charity shops Coffee shop Day care Driving: A Flower arranging Fundraising A) for patientsB) for fundraising BGardening Reception Wards Other (pleasespecify)Training and guidance will be given where necessary.OtherTransportAre you a car driver?Would you be willing to use your car for volunteer purposes (travel expenseswill be paid)? YES NO YES NOAvailabilityPlease specify the approximate number of hours you are able to give on each day (this will help us identify asuitable vacancy).Monday Tuesday Wednesday Thursday Friday Saturday SundayMorningAfternoonEveningPlease give any further information concerning your availability below, for example: “my time varies weekto week”.Would you be willing to be placed on a Fundraising Department ‘on call’ list, to be contacted forvolunteering opportunities (this may be at short notice)? The activities may include things such as bag packingat supermarkets, street bucket collections, major events such as the annual Summer Fairs or third party eventssuch as golf days etc. YESComments: NOSupporting InformationPlease tell us why you want to volunteer for St Ann’s Hospice?

Qualifications, Training & ExperiencePlease give details of any qualifications and/or training and experience which you feel is relevant to yourapplication. Please note: Qualifications, training and previous experience are not always required for voluntaryposts as training and support specific to the role is provided on appointment.Interests and HobbiesPlease give details of any interests or hobbies that you have that you may be willing to use as part of yourvoluntary work to support the hospice, e.g., arts and crafts.ReferencesTwo written references are required to support all volunteer applications. The names given should be ableto testify to your suitability for this voluntary work. They should be someone you have recently known forover two years, e.g. past/present employer, college tutor but must not be a relative.Title:Title:Name:Address:Name:Address:Postcode:E-mail address:Tel. Number:Relationship to you:Postcode:E-mail address:Tel. Number:Relationship to you:

DisabilityThe Disability Discrimination Act defines disability as ‘a physical or mental impairment which has asubstantial long-term adverse effect on a person’s ability to carry out normal day-to-day activities’.Do you consider yourself to be disabled in line with theabove definition?If yes, please state the nature of your disability YES NOEqual OpportunitiesSt Ann's Hospice has an Equal Opportunities policy, the aim of which is to ensure that no applicant or volunteerreceives less favourable treatment or is disadvantaged by requirements which cannot be shown to be justified. Inorder to ensure that this policy remains effective, you are requested to answer the following questions (but it isnot a legal requirement). This form will be treated in the strictest confidence and is designed formonitoring purposes only.Gender: MALE / FEMALEMarital Status: SINGLE / MARRIED / CIVIL PARTNERSHIP / LIVING WITH PARTNER / OTHERIf other please specify:ETHNIC ORIGIN (please tick) : White British White Irish Any other white background Mixed – White & Black Caribbean Mixed – White & Black African Mixed – White & Asian Any other mixed background Chinese Asian or Asian British – Indian Asian or Asian British – Pakistani Asian or Asian British – Bangladeshi Any other Asian background Black or Black British - Caribbean Black or Black British – African Any other Black background Any other background (please state)………………… Do not wish to give detailsPrior to the commencement of any voluntary role, you will be asked to attend an informal interview and yourreferences will be requested. A Criminal Records Bureau Disclosure will be undertaken for all posts based withinthe hospice (this includes Heald Green, Little Hulton and The Neil Cliffe Centre). Although convictions will notnecessarily be a bar to you obtaining a voluntary position with us, these checks enable us to make saferrecruitment decisions for the benefit of our patients.Have you ever been convicted, cautioned, reprimanded or given a warning for a YES*criminal offence? NO*If Yes, please give details on a separate sheet and enclose in a sealed envelope marked For the attention ofPersonnel Director, and return with your completed application form.DeclarationI understand that I am not applying for a paid position. I declare that to the best of my knowledge theinformation I have given on this form and accompanying documents is true and current. I understand thata false statement may result in termination of a voluntary appointment made from this application.Signature:Date:St Ann’s Hospice is a registered charity, number 258085.