Personal details
Please Tick
Name
Male
Age
Female
Date of Birth
Address
Postcode
Home Phone No.
Mobile
Email
Emergency Contact Details
Name
Contact Tel No.
Address
Postcode
Please give brief details of your skills and experience that might be useful in this role. This can
include your employment background, previous volunteering, relevant training etc.
Please give brief details. This can include hobbies, interests
Any previous voluntary experience you would like to tell us about (if not mentioned above)
If there is not enough space in any of these boxes, please write it on a separate piece of paper and
attach it to this form
Please tick the kind of voluntary work you are interested in:
 Any
 Group
 volunteering alone
 Collections
 Fundraising
 Front of house/reception
 Assisting staff members
 Administration  Other (please use the line below)
____________________________________________________________________________
Time availability
When can you volunteer: tick the times below that apply:
 Daytime
 Evening
 Any time
 Weekdays
 Weekends
 Other
References / additional information
How did you find out about our volunteering opportunities?
 Advert
 From a visitor
 Our Website
 Another Website
 From a current volunteer
 Local Volunteer Centre  Other _____________________________
Please give us details of somebody who could supply a reference; (Please note, we do not
always follow up on references only if we need to)
Name of Reference
Address
Contact No.
Postcode
Email
Data Protection Act 1998
Nottingham Industrial Museum (NIM) will only use the information provided by you to assess your
suitability to volunteer with us. We reserve the right to gather information from other sources too, for
example, by using your reference. We will not contact other parties without asking you first.
Once you completed this form please return it to either the
Nottingham Industrial Museum at weekends between 11am – 3pm
Or by email to volunteer@nottinghamindustrialmuseum.co.uk
Or by post to;
Mr A Burton – Volunteer Co-ordinator
4 Westwick Road
Bilborough
Nottingham
NG8 4HF
Nottingham Industrial Museum aims to provide equal opportunities and a fair treatment for
volunteers. Please complete this form and return it to the Volunteer Co-ordinator along with your
Application form.
All details are held in accordance with the Data Protection Act 1998
We would like you to complete this form in order to help us understand who we are reaching and
to better serve everyone in our community.
As a voluntary organisation we are committed to treating all volunteers with dignity and respect
regardless of age, disability, gender reassignment, marriage and civil partnership, race, religion
or belief, sex and sexual orientation.
You do not have to answer any questions you are uncomfortable with
Please check the appropriate boxes;
1.
Gender
2.
Which age group do you fall into?
3.
Male
Female
16 - 24
25 - 29
30 - 39
50 - 59
60 – 69
70+
40 - 49
50 - 59
How would you describe your ethnic origin?
White British
Multiple Heritage
White Other
Asian or Asian British
White European
Chinese
Black or Black British
Other ethnic group
4.
Would you describe yourself as having a disability or impairment?
Yes
5.
please state
No
Do you identify as?
Heterosexual
Transgender
Gay / Lesbian / Bisexual
Transexual
I do not wish to disclose my sexuality
6.
Do you have a Religion or belief?
Atheism
Jewish
Christianity
Sikhism
Buddhism
Other
Islam
I do not wish to disclose my religion