Personal Details
First Name*
Last Name*
Address
Street Address
Street Address2
City/Town*
Post Code
Telephone
Home*
Work
Mobile
Gender
Date of Birth (dd/mm/yy)
Work Experience:
Are you presently in paid employment?
Occupation
If no, please summarise any previous work experience:
Have you ever participated in volunteer work before?
Are you actively involved with any other organisations?
If yes, please state where and what type/roles performed?
Reasons for Volunteering: (why do you volunteer or wish to volunteer?)
How have your own experiences of illness/loss influenced your desire to work as a volunteer?
Abilities / Strengths: (please identify some of your personal qualities and strengths)
Personal Interests: (eg. your leisure activities, hobbies)
Education / Training / Qualifications: (please share details of you achievements and any future plans)
Health: (Please specify any physical/medical condition that might present a problem for you or a member in the course of your volunteering. Eg. Hearing, vision, lifting, stamina)
Experience of Cancer:
Do you have or have you had cancer yourself?
If Yes: Please give a brief history
If No: What contact, if any do you/did you have with a cancer patient?
Availability for Volunteer work:
Are you available -
during the week?
at weekends?
How many hours would you be able to contribute?
Transport:
Have you
A valid drivers licence?
Your own transport?
Referees: (Please supply the names, addresses, and phone numbers of two
people willing to provide either a work-related or character reference
for you)*
Referee 1
Referee 2
Contact Person: (in the case of an emergency, who would you like CanTeen to contact. Please state person's name, address, phone number and nature of the relationship eg.parent, flatmate)
Volunteer Roles and Responsibilities (Contract): attached for further information
Occupational Health and Safety: Volunteers and Staff have a responsibility under Section 19 of the Health and Safety in Employment Act 1992, to behave in a safe manner to ensure the health and safety of themselves and others in the workplace.
Agreement: I have read and understood the Code of Confidentiality declaration and agree that the information provided in this application is full and correct. I give permission to add this information to: 1) CanTeen National Office database. 2) CanTeen Mailing list. 3) Pass information onto local divisions to help ensure an effective Volunteer Placement. I also give permission for media material, which includes myself to be used for the purpose of promotion and publicity of CanTeen activities.
By Submiting this form, you agree that CanTeen may contact any of my
nominated referees to help with volunteer selection and placement.