Volunteer Application

Name*

Date of birth*

Address*

Mobile Phone

Phone

Email*

Emergency Contact Details

Contact Name*

Phone*

Mobile Phone

References

We ask that you provide two people we can contact for references who can comment on your suitability to undertake voluntary work for Willow Wood Hospice. We ask that your referees have known you for a minimum of 12 months and are not family members.

1st Reference Name*

1st Reference Address*

1st Reference Email

1st Reference Phone*

2nd Reference Name*

2nd Reference Address*

2nd Reference Email

2nd Reference Phone*

Fitness to Volunteer

Do you have any medical conditions or disabilities that we should know about in order to keep you safe whilst volunteering with us?*

Yes

If yes, please give details

Rehabilitation of Offenders Act

The Hospice is exempt from the provisions of Section 4 (2) of the Rehabilitation of Offenders Act by virtue of the Rehabilitation of Offenders Act (Exceptions) Order 1975. You must declare any convictions you may have had including convictions which for other purposes are ‘spent’ under the provisions of the Act. Any information given will be completely confidential and will not necessarily disqualify your application for becoming a volunteer.

Have you ever been convicted, cautioned, reprimanded or given a warning for a criminal offence?*

Yes

Declaration of Confidentiality*

I understand that I must adhere to the procedures and standards of Willow Wood Hospice. I understand that it is important that I meet my time commitments and give as much notice as possible if I am unable to attend as expected. I understand that anything heard or learned in the course of my duties concerning staff, volunteers, individual patients or the work of the hospice must be treated in the strictest confidence. Once investigated, any breach of confidentiality could result in the termination of my voluntary role.

The General Data Protection Regulation Article 6 legal basis for processing the personal information submitted on this form is that you have provided consent for us to do so. The General Data Protection Regulation Article 9 legal basis for processing the special category personal information submitted on this form is that you have provided explicit consent for us to do so. It will be retained for the duration of your volunteering application and relationship with Willow Wood Hospice for this purpose, and for 6 years following the end of your volunteering term in line with the NHS guidelines for records management and our Privacy Policy. You can see our full privacy policy on our website: www.willowwood.info/about-us/privacy-policy. The data may also be shared with campaign support providers for the smooth running of the campaign only and may be stored outside the UK but not outside the EU. You have the right to correct, erase, have access to and restrict our use of your information. In order to exercise any of these rights, please contact siro@willowwood.org.uk. If you are unhappy about the way in which your information is processed you have the right to contact the Information Commissioners Office: 0303 123 1113

You must be 13 years old or over to volunteer with us. If you are under 16 years old, please ask a parent or guardian to sign below to give their permission for you to become a volunteer.

Are you applying as part of your Duke of Edinburgh or similar award scheme?*

Yes

I, the undersigned, as parent/legal guardian of the person named on this application, hereby give my consent to their application as a volunteer for Willow Wood Hospice.

Name of Parent/Guardian

Relationship

Areas of interest and skills

Please tell us what area(s) you are interested in. We will always try to find a suitable vacancy that fits your availability and skills, however please be aware that a vacancy may not always be available in your area of interest. Please note we do not accept volunteers under 18 years of age for work at the Hospice but applications are accepted for working within our shops.

Working in the Hospice - General Areas

The Hive

Assistant

Arts and Crafts

Admin/Clerical

Therapist

In Patient Ward Assistant (Mon-Sun)

9am – 1pm

4:30pm-7:30pm

Reception (Mon-Sun)

8:30am – 1.00pm

1:00pm – 5:00pm

5:00pm – 8:30pm

Shops

Please tell us about any skills and experience you have and your reasons for wanting to volunteer with Willow Wood Hospice.

Volunteer Declaration*

I declare that the information given on this form and supporting documents, is complete and correct to the best of my knowledge. I understand that any false information may result in me being asked to cease volunteering for Willow Wood Hospice. I understand that in order to undertake my position safely, I will have to undertake mandatory training relevant to my area of work, and attend a Welcome Day within the first 6 months of commencing my volunteer role.

How did you hear about Willow Wood and our volunteering opportunities?

Via other volunteers

Willow Wood website

Visiting the hospice

Social Media

Visiting a Willow Wood Shop

Newspaper Advert

Local Radio

Other

Emergency Contact Details

References

Fitness to Volunteer

Rehabilitation of Offenders Act

Areas of interest and skills

Information

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