Volunteer Application Form

Application as a volunteer

Once your application has been successfully submitted you will receive a confirmation email subject: St Luke's Hospice application confirmation.

Full Name *

Address *

Line 1 *
Line 2
Town *
County
Postcode *
Country

Gender *

Age Group: Please indicate that you are over 18 years of age *

If under 18, are you applying as part of your Duke of Edinburgh award scheme?

Contact telephone number *

Email address

Areas of interest: Please tell us the general areas in which you are interested in volunteering. Please refer to the guidance notes which detail any specific requirements for particular volunteering opportunities. We cannot guarantee your first preference will be met, however, this will assist us when we consider your placement. +

Please indicate your availability each week e.g. Monday morning; Monday afternoon, Monday evening. Typically, shifts are 4 hours. *

We will try to make arrangements as you have requested, however sometimes we have a need for volunteers on specific days or times each week. Would you be able to consider volunteering other than on the days / times that you have indicated? *

Yes
No

Alternatively, please tick here if you would like to be called upon on an AD HOC BASIS ONLY

If you selected 'In our shops', which shops? Please mark all that you would consider if you are volunteering for work in a shop

Please explain why you would like to volunteer with St Luke’s Hospice Charity Shops *

Special skills or qualifications Qualifications (if relevant)

Experience – an idea of your current or previous working life would be useful to us

Skills - that you are happy to continue to use for our Hospice - for example, can you type, use a computer, do bookkeeping, cook, paint, arrange flowers etc?

Any other information you think may be useful to us

Person to notify in case of emergency *

Line 1 *
Line 2
Town *
County
Postcode *
Country

Contact telephone number *

Relationship to you *

St. Luke’s is entrusted with the care of patients, and volunteers may also handle money or gifts from the public. Please give the names of two people over the age of 18 years, whom we can contact for a reference. They can be friends, neighbours or work colleagues, other volunteers etc., (but not a relative, or your doctor or a member of staff currently working in our Charity Shops.)

First referee name, address, contact telephone number and email address *

Relationship to you *

Second referee name, address, contact telephone number and email address *

Referee relationship to you *

Criminal Records Bureau (CRB) Enhanced Disclosure will be requested from the Criminal Records Bureau for successful hospice based applicants. Under the provisions of the Care Standards Act 2000, Hospice volunteers are exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974. You are not entitled to withhold information about anything on your criminal record however long ago these occurred and which for other purposes are “spent”, under these provisions. Information given will be confidential and will be considered only in relation to this application. CRIMINAL CONVICTIONS, CAUTIONS OR BINDING OVER ORDERS Voluntary appointments are covered by the Rehabilitation of Offenders Act 1974 (Exceptions) Amendment Order 1986, and you are therefore required to disclose the above to us, however long ago these occurred.

Have you any spent or unspent criminal convictions, or cautions or binding over orders? *

Yes
No

If YES please give brief details together with dates:

Birthday Cards – It is our tradition to celebrate our volunteers’ birthdays by sending a greetings card. We are only able to do this if we have their date of birth. We would appreciate it if you would provide this information. (dd/mm/yyyy)

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may preclude me from volunteering for St Luke’s. St Luke’s Hospice welcomes volunteers without regard to race, colour, religion, national origin, gender, sexual preference, age, or disability.

Volunteer Application Form

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