Volunteer Form

If you are a human and are seeing this field, please leave it blank.

Fields marked with an * are required

Personal Details

First Name *

Last Name *

Address 1 *

Address 2

City

Post Code *

Phone *

Alternative phone number

Are you aged... *

Between 14 - 18 years?
Over 18 years?

Emergency Contact Details

First Name *

Last Name *

Phone *

Mobile Phone

Relationship

What role(s) are you interested in?

Hospice Role

Retail Shop

If retail shop please let us know which shop/s

Neighbourhood Hub

If Neighbourhood Hub, which location?

Fundraising Events

Warehouse

Van Drivers Mate

Administration

When are you able to volunteer?

What is your current/previous occupation? *

Do you have any experience, knowledge skills and personal qualities that you feel are relevant to volunteering? (Please explain below) *

Please tell us why you would like to volunteer for us *

Please provide the details of your reference or references.

Hospice roles require 2 references -If possible 1 reference should be professional and the other personal.

ALL other roles require 1 reference - Either personal or professional.

References must not be a family member and need to have known you for at least 2 years.

First Name *

Last Name *

Phone *

Mobile Phone

Address 1

Address 2

City

Post Code

Relationship

Reference 2 (for those applying for hospice roles only)

First Name

Last Name

Phone

Address 1

Address 2

City

Mobile Phone

Post Code

Relationship

Additional Information

If yes, please provide details

GP Information ( Your GP will only be contacted with your permission)

Name

GP Surgery

If Yes please give details on a separate sheet and enclose with this application. The information will be treated in strict confidence.

Under the Rehabilitation of Offenders Act 1974, you are required by these provisions to declare all criminal convictions however long ago these occurred. Disclosure of an offence will not necessarily be a barrier to becoming a volunteer with us.

DBS checks: successful candidates may be required to complete a DBS check and personal identification documents will be needed as part of this process.

If yes please provide their name and role

Where did you hear about volunteering for us? *

By ticking this box I confirm that in accordance with the Data Protection Act 1998 and General Data Protection Regulation (May 2018), I hereby consent to Cornwall Hospice Care holding and using my data in connection with volunteering. This information will be held securely and only accessed by authorised personnel. I declare that the details provided on this form are, to the best of my knowledge, true and correct *

Print Name *

Date *

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