Volunteer Application Form

If you have any questions about this form please don’t hesitate to contact us.

We ask volunteers to commit to spending 12 months with us, if possible.

1. Personal Information
Title (Ms/Mrs/Dr etc.)
Last Name
First Names
Home Address
Contact Details	Home Tel
Work Tel
Mobile
Email
Emergency Contact	Name: Phone No:
2. Volunteering
What area(s) of voluntary work are you interested in/applying for? (click on chosen tick box) ☐ Administration ☐ Befriending ☐ Counselling ☐ Deliver activities, leisure, crafts ☐ Fundraising ☐ Gardening Group Work ☐ Reception ☐ Social Media ☐ Website support ☐ Trustee ☐ Other (Please state)
How did you hear about the role that you are applying for? (click on chosen tick box) ☐ Word of Mouth ☐ You have accessed services ☐ An advert for volunteer role , if so where did you see the advert ☐ Swan Womens Centre website ☐ A friend/relative volunteers at Swan Womens Centre ☐ Social Media ☐ Other: Please give details
Do you have any additional support needs/requiring reasonable adjustments to undertake a volunteering role or for any training required? (click on chosen tick box) Yes ☐ No ☐ Details (this can be discussed at interview/induction stage if preferred)
Please give your reasons for wanting to volunteer with us.
3. Interests and Experience
Please give an outline of relevant present or past experience, including any other voluntary work you have undertaken. Please use separate sheet if required:
Please give an outline of your experience, skills, education or training in relation to the role you are interested in (please note that most roles at SWAN may require literacy, numeracy and IT skills).
Do you have any hobbies or interests that may be helpful in your volunteer role?
3. Availability
When and how often are you available to volunteer? (click on chosen tick box) am pm Eve(4-8pm) Monday ☐ ☐ ☐ Tuesday ☐ ☐ ☐ Wednesday ☐ ☐ ☐ Thursday ☐ ☐ ☐ Friday ☐ ☐ ☐
References – Please give the name, address and email (where possible) of two people who could be contacted by us to give a reference. The referees should include a previous employer if you have one but it can be from somewhere else you have volunteered or from someone who has known you well for at least 2 years (not a relative). 1: Name: Email: Postal Address: Phone Number: Relationship to you: 2. Name: Email: Postal address: Phone Number: Relationship to you:
You will be required to undertake a DBS check, we may ask you for have an Enhanced DBS check, it depends on the role, and this will show any convictions and potentially any cautions you have had. We ask that you tell us in advance of us receiving this information, so that we can discuss any risk or impact this may have on your ability to carry out the role that you have applied for. With this in mind, is there anything you would like to highlight or discuss in advance of the DBS check. (click on chosen tick box) Yes ☐ No ☐ Details:

Personal Data

SWAN holds personal data about you as part of our personnel records, and may need to use such information in the course of carrying out its business. By signing this registration form, you specifically consent to SWAN holding and processing your personal data, including sensitive data, under the terms of the Data Protection Act 1998.

Equal Opportunities Policy

SWAN operates a policy of equal opportunity for all, regardless of race, sexuality, marital status, dependents, age, class, religion, disability or offending background, where this does not create a risk to others. This provision will be reflected in all aspects of the work of this organisation.

If a Volunteer Placement is offered

Volunteer Agreement Declaration

I understand that there is no intention to create a legally binding relationship between the volunteer and SWAN.

This agreement is not intended to be a legally binding contract between us.

I have received and agree to abide by the Volunteer Policy and Codes of practice.

I understand and agree to follow all SWAN instructions, health and safety procedures, confidentiality and codes of best practice.

I understand that SWAN will pay out of pocket expenses only upon production of receipts.

Car insurance

Please note if you use your car in your volunteering role you are required to inform your insurance company as it may affect any claim you make if you do not declare this. We require a copy of your current car insurance company confirming that you have comprehensive cover if you carry any passengers during your volunteering role.

Volunteer Signature:	______________________Date________________

Only sign the acknowledgement below if you are applying for a Trustee Positions

I declare that:

I am over age 18.

I am willing to act as a full Trustee of the SWAN Women’s charity

I confirm that I will support the Objects of the charity

I am not an undischarged bankrupt.

I have not previously been removed from trusteeship of a charity by a Court or the Charity Commission.

I am not under a disqualification order under the Company Directors' Disqualification Act 1986.

I have not been convicted of an offence involving deception or dishonesty (unless the conviction is spent).

I am, in the light of the above, not disqualified by the Charities Act 1993 (section 72) from acting as a charity trustee.

I undertake to fulfil my responsibilities and duties as a trustee of the SWAN Women’s Centre in good faith and in accordance with the law and within the SWAN Women’s Centre objectives /mission.

I do not have any financial interests in conflict with those of the SWAN Women’s Centre (either in person or through family or business connections) except those which I have formally notified in a conflict of interest statement. I will specifically notify any such interest at any meeting where trustees are required to make a decision which affects my personal interests, and I will absent myself entirely from any decision on the matter and not vote on it.

I confirm that if my employment (or employment status) changes, I will inform the Board and update my disclosure of conflict of interests.

I am not disqualified under the Protection of Vulnerable Adults List.

Please note that appointment to this role may be subject to appropriate DBS and other checks.

Potential Trustee Signature:	______________________Date________________

Approved Volunteer Application

To be completed by SWAN Women’s Centre Staff.

Volunteering Role:

Line Manager:

Start Date:

Days/Hours of Volunteering:

am	pm	Eve (4-8pm)
Monday	☐	☐	☐
Tuesday	☐	☐	☐
Wednesday	☐	☐	☐
Thursday	☐	☐	☐
Friday	☐	☐	☐

(please circle or tick chosen tick box)

Any Adjustments Required: Yes ☐ No ☐

Details:

Risk Assessment Carried Out: Yes ☐ No ☐

Volunteer Induction Carried Out: Yes ☐ No ☐

Volunteer Policy & Induction Pack Provided: Yes ☐ No ☐

Access to Health and Safety Policies Provided: Yes ☐ No ☐

Out of Pocket Expenses explained: Yes ☐ No ☐

Clinical Supervision explained (counsellors only) Yes ☐ No ☐

DBS check: Yes ☐ No ☐

References check: Yes ☐ No ☐

If Driving is required as part of the volunteer role a copy of Insurance showing business use/MOT/ Driving License is required.

Signed by (Member of staff)

Print Name:………………………………..

Signature ………………………

Date: / /