Volunteer Form - Birmingham Mind

VOLUNTEER ROLE YOU ARE APPLYING FOR

NAME*

First Last

DATE OF BIRTH*

EMAIL*

PHONE*

ADDRESS

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Why would you like to do this volunteer role with Birmingham Mind? (What are your motives and goals?)

What skills, interests, knowledge and experience do you have?

Please state any additional languages you speak other than English?

Do you have any medical conditions or disabilities that may affect your volunteering, or that staff need to be aware of? If yes, please provide further information

When can you volunteer with us? (Please read the role description for hours)

Weekdays between 9am - 5pm

Evenings 5pm - 11pm

Weekends

How many hours could you give regularly each week? Our usual time commitment is 4 hours per week

Please give details of two emergency contacts

NAME OF FIRST EMERGENCY CONTACT*

First Last

Phone*

Relationship to you

NAME OF SECOND EMERGENCY CONTACT

First Last

Phone

Relationship to you

Please give details of 2 referees

Please give details of 2 referees. Please note that these should NOT be related to you nor live at the same address as you. Referees should have known you for 2 years or more. References will be requested via email.

NAME OF PROFESSIONAL REFEREE*

First Last

A person who knows you in a professional context. For example; Employer, Teacher, Social Worker, Minister of Religion or Sports Coach.

How do they know you?

Job Title / Organisation

Email*

Phone

NAME OF CHARACTER / PERSONAL REFEREE*

First Last

A person who has known you for a minimum of two years. This person must not be a relative nor live at the same address.

How do they know you?

Email*

Phone

Please let your referees know that we will be requesting a reference so that you can give your consent.

Do you have any criminal convictions, cautions, reprimands, final warnings (spent or unspent), which are not protected by Rehabilitation of Offenders legislation?

We will request a DBS check for all volunteers before you start in your role and whilst having a conviction will not stop you volunteering it will be considered when assessing suitability for a role.