Volunteer application form

If you'd like us to consider you for a voluntary role at St Luke's please complete this form.

Please make sure you fill in all the mandatory fields on this form (shown by the red star * symbol) before you submit it.

Personal Details:

Title *

First name *

Last name *

Date of birth *

Address

Line 1
Line 2
Town
County
Postcode
Country

Contact Details:

Home telephone

Work telephone

Mobile number

Email *

Next of Kin Details

Next of Kin *

Relationship *

Daytime Tel no. *

More information:

Why do you want to volunteer for St Luke's? *

Describe any paid/voluntary experience, training/qualifications that may be relevant (this could include experience in the home, with family or in school). *

What knowledge/abilities/skills could you bring to your role at St Luke's? *

Have you experienced a bereavement in the last 6 months? *

YesNo

References:

Personal referee 1. Please include full postal address & contact details. *

Please give names & addresses of 2 referees (not family members) who've agreed to give an opinion of your character, ability & experience, & who have known you for at least 2 years.

Referee 1 email address

Please provide an email address for your referee

Personal referee 2. Please include full postal address & contact details. *

Please give names & addresses of 2 referees (not family members) who've agreed to give an opinion of your character, ability & experience, & who have known you for at least 2 years.

Referee 2 email address

Please privde an email address for your referee

Availability:

When are you available to volunteer? Please tick all that apply. *

Which areas would you like to volunteer?

Please specify here which volunteer role you are applying for, and the volunteer position number. *

Volunteer position number can be found on the volunteer task profile.

Criminal Bureau (CRB) Checks:

Have you ever been convicted of a criminal offence? *

YesNo

All applicants offered an opportunity as a volunteer will be subject to a criminal record check from the Criminal Records Bureau before the appointment is confirmed. This will include details of cautions, reprimands or final warnings as well as convictions. St Luke's Hospice abides by the strict CRB Code of Practice on disclosures; any conviction disclosure would not necessarily bar you from volunteering.

If Yes, please provide full details

Agreement and declaration:

If I'm successful in becoming a volunteer at St Luke's Hospice, I agree to abide by the policies & procedures of the Hospice. I also agree to undertake any training that may be necessary for my volunteer role. *

I agree

I understand that anything I hear or learn concerning individual patients or my work at St Luke's in the course of my duty as a Volunteer must be treated in strictest confidence. *

I agree

I confirm that the information on this form is true & correct. In accordance with the Data Protection Act 1998 I give permission for this personal information to be stored & processed for the purposes of volunteering & monitoring & for sensitive data to be stored & processed in connection with equal opportunities, health & safety reasons & compliance with the requirements of national standards. *

I agree