Apply to be a volunteer

Personal Information

Sex

Do you have a medical condition or disability that may affect you volunteering in the role you have applied for? If so, please provide information below.

Person to notify in case of emergency

Role-based information

Have you been bereaved of a close family member or friend in the past 12 months? If yes, please give details. (please note that St Luke’s has a policy that does not allow new volunteers to volunteer at the hospice if they have been bereaved in the last 12 months and/or are receiving bereavement support)

Are you currently accessing bereavement support through St Luke’s Hospice?

Do you have any relatives or close friends currently at St Luke’s Hospice or using the day centre facilities?

References

Please provide two referees over the age of 18 years. Please note that these can not be family members or friends.

(If you are having difficulties providing suitable referees, please email volunteering@stlukes-hospice.org)
 

Reference 1

Reference 2

Criminal Convictions

 
Any information you supply on this form is confidential and will only be used in respect of your voluntary placement in line with the Data Protection Act 1998. By submitting this application form you consent to St Luke’s Hospice using this information for this purpose. Any information given will be considered only in relation to applications for positions covered by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975.

Applicants are not entitled to withhold any information about criminal convictions, however long ago these occurred. Failure to disclose such convictions could result in being released from a volunteer role. 


 
 
Have you ever received a criminal conviction? If you have answered yes, please provide details below. (You are also able to disclose with the volunteering team over the phone or in a separate email if preferred)

Communication from St Luke's

St Luke’s will stay in touch and keep you up to date with the work that we are doing, to tell you about the amazing difference that you have made, and about future events, fundraising activity and other ways of getting involved. Visit www.stlukes-hospice.org/yourdata to find out more about how we use your information.



How did you hear about us?






Agreement and Signature

I confirm that the information supplied is accurate and that I have not knowingly withheld any information which is relevant to the application. 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.
I confirm that the information supplied is accurate and that I have not knowingly withheld any information which is relevant to the application. 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.

Our Policy

St Luke’s Hospice welcomes volunteers without regard to race, colour, religion, national origin, gender, sexual preference, age, or disability.