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Improving the lives of people with learning difficulties and disabilities Volunteers Registration Pack. Please complete this document and return it to: [email protected] or to the office at: People in Action 3rd Floor Symons House Belgrave Street Leeds LS2 8DD If you need help filling out this document please get in touch: www.peopleinaction.org.uk 0113 2443729 [email protected] Registered Charity in England and Wales No. 701434. Company Limited by Guarantee No. 2361654 Improving the lives of people with learning difficulties and disabilities Volunteering Application Form Name D.O.B. Address Tel No Mobile Email What is your preferred method of contact? Please give details of any disability or medical condition you feel we should know about… Have you any particular interests or hobbies (past or present) which could be shared with somebody? Have you worked as a volunteer before? (please give details) 2 When are you available to volunteer? Daytime Evenings Weekdays Weekends (Mon-Fri) (Sat – Sun) Other (please say) Do you have a full, clean driving license? Yes No Do you have transport available? Yes No Improving the lives of people with learning difficulties and disabilities References Please give the names of two referees, for example: employer, tutor, long-standing friend (not a relative). People In Action works with vulnerable people and we always take up references. Reference 1 Name Address Tel No Email Relationship to you Reference 2 Name Address Tel No Email Relationship to you 4 Please give details of any criminal convictions (if applicable) so that we can take them into account when considering your application. (Exemption under the Rehabilitation of Offenders Act does not apply) We have to check with the Criminal Records Bureau for any record of criminal convictions, which may affect your application. In order to do this we need the following information: Date of birth Name (if you were previously known by another name). Date Signature (under 18s please get your parent/guardian to sign for you) Improving the lives of people with learning difficulties and disabilities Photography consent form People In Action may take photographs or record videos of its projects or events. This material may be used to promote the work of People In Action through press and publicity materials, for example Newsletters, Leaflets and the People In Action website. Please indicate as to whether you DO or DO NOT permit to the careful use of your photograph in any of the following: Leaflet: Website: Newsletter: Name Date Signature 6 I DO give permission I DO NOT give permission I DO give permission I DO NOT give permission I DO give permission I DO NOT give permission Volunteer’s Agreement People In Action are mindful that people’s circumstances may alter over time and so any commitment made to volunteering may have to change. However, as People In Action tries to avoid letting people down, we would ask you to ensure that you can keep to any commitment you make to volunteering as far as possible. If any change has to be made, please try to give as much notice as you can. I have read and understood People In Action’s Volunteers’ Policy and agree to the requirements for volunteering with People In Action. I agree to undertake training in, and work in accordance with, People In Action’s policies. I will inform People In Action if I wish to change, or end, my arrangements for Volunteering. Please register me as a People In Action Volunteer. Volunteer’s Signature Name Date Improving the lives of people with learning difficulties and disabilities Equal opportunities form Inline with our equal opportunities policy, People In Action would like you to answer the following questions. Filling in the form is optional. This form is only used for monitoring to make sure that our procedures are as fair as possible. Gender: Male Please tick the boxes that best describe you. Female Do you have a disability? Yes No Age group: 0 - 11 12 - 20 21 - 30 31 - 40 41 - 50 51 - 60 61 -70 Ethnic origin: White British European Other – give details Mixed White and Black Caribbean Other – give details Asian or Asian British Indian White and Black African Pakistani Bangladeshi Other – give details Black or Black British Caribbean Other – give details Other ethnic groups – give details 8 African White and Asian 70 +