Volunteer Expression of Interest

Your Details

Title*

Forename*

Surname*

Address 1*

Address 2*

Address 3*

Postcode*

Contact Number*

Email*

Volunteer Role*

If selected other, please give details:

Please tell us about your access requirements or support needs if applicable

Please tell us why you are interested in volunteering for Crossroads Care Rotherham*

Please tell us about any skills or experiences you have that may be relevant to befriending people, or any hobbies or interests that may be useful in voluntary work with us

Education

Please tell us about your school/college/university history starting with the most recent (including course names and dates)*

Employment/Volunteering History

Please tell us about your employment/volunteering history including any gaps and why*

Please outline your availability (please be specific including days and times)*

Emergency Contact

Emergency Contact Name*

Emergency Contact Number*

References

Please provide name, address, contact number and email of two people who can provide a reference for you

Reference 1*

Reference 2*

REHABILITATION OF OFFENDERS ACT 1974 and EXCEPTION ORDER 1975

Because of the nature of the work for which you are applying, you must provide information about any convictions. Our power to require this lies in the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975, which removes the normal operation of the Act in relation to specific occupations, including the provision of Home Care Services. In the event of being employed in connection with this application, any failure to disclose such convictions could result in dismissal or disciplinary action. Crossroads Care Rotherham follows a Code of Practice about the fair use of disclosure information, and a copy is available on request. If you do have any previous or outstanding convictions, details of the type of offence, date, sentence, fine etc. should be brought along with you to the interview, should you reach this stage. A criminal record will not necessarily be a bar to obtaining a position.

Do you have any criminal convictions, cautions, reprimands or final warnings?*

If yes please provide further information

Equality & Diversity

How would you describe your cultural or ethnic origin

Gender Identity

If other please specify

Is your gender the same as assigned to you at birth?

Sexual Orientation

If other please specify

Religeous Belief

If other please specify

Marital Status

Do you consider yourself to be a disabled person

DISABILITY DISCRIMINATION ACT 2005

A person has a disability under the Disability Discrimination Act if he/she has a physical or mental impairment which has a substantial and long term diverse effect on his/her ability to carry out normal day-to-day activities. Long term means has lasted, or is expected to last for 12 months.

I declare that all the information I have given on this form is true and accurate, to the best of my knowledge*

Crossroads Care Rotherham

About Us