Volunteer Application Form
Please ensure that all questions are answered as fully as possible.
Personal Details
SURNAME:
……………………………………………… FORENAME(S): …………………………………………
(MR/MRS/MISS/MS)
DATE OF BIRTH ..........//………..//……………
ADDRESS (HOME)
ADDRESS (TERM TIME) (if applicable)
…………………………………………………………………
…………………………………………………………………
…………………………………………………………………
…………………………………………………………………
…………………………………………………………………
…………………………………………………………………
…………………………………………………………………
…………………………………………………………………
TELEPHONE NUMBER (HOME)……………………………………………(WORK)…………………………………………..
(MOBILE)……………………………………E-MAIL ADDRESS…………….……………………………………………..........
Experience
Have you had any previous voluntary experience?
If yes, please give details
YES/NO
Are you engaged in any form of volunteering at the moment?
Please give details
YES/NO
Please tell us why you are applying to volunteer within this Trust.
Employment
Please state previous/present occupation
Skills
What skills, knowledge, interests or hobbies can you offer as a volunteer?
Please give details.
Our
Trust is
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Do you speak any other languages?
Please give details
Do you hold a current driving licence (without endorsement)?
Please give details
Do you have your own transport?
Yes/No
Yes/No
Yes/No
Availability/Interest
Please tick when you will be regularly available to volunteer.
DAY
Monday Tuesday Wednesday Thursday Friday Saturday
Morning
Afternoon
Evening
Commitment: Please note a minimum commitment of 6 months is normally required.
Health
To the best of your knowledge are you in good health and capable of safely undertaking volunteering?
Sunday
Yes/No
If no, please give BRIEF details
All health information is treated in confidence.
It is your responsibility to inform the Head of Volunteering if there is any change in your health in the future.
References
Please give details of 2 people who know you well (i.e. have known you over 2 years through work or volunteering or in a
professional capacity, but are not friends or family) who have consented to act as referees on your behalf.
Name: ………………………………………………………...
Name: ………………………………………………………...
Capacity in which referee is known to you:
Capacity in which referee is known to you:
………………………………………………………………….
………………………………………………………………….
Address:………………………………………………………
Address:………………………………………………………
…………………………………………………………………
…………………………………………………………………
…………………………………………………………………
…………………………………………………………………
……………………………………………………………….
……………………………………………………………….
Post Code:……………………………………………………
Post Code:……………………………………………………
Telephone Number:…………………………………………..
Telephone Number:…………………………………………..
E-Mail Address:………………………………………………
E-Mail Address:………………………………………………
Where did you hear about this volunteering?
 NHS Website
 Volunteer Bureau
 Trust Website
(Please Give Details)
 Search Engine
 Other Website
 University
(Please Give Details)
(Please Give Details)
 Local Newspaper
 College
(Please Give Details)
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 Doctor/CPN/Social Worker/OT
(Please Give Details)
 Other
(Please Give Details)
Rehabilitation of Offenders Act 1974
Voluntary posts within this Trust are exempt from the provisions of the above Act. This means that you must disclose
details about criminal offences, even if they are “spent” under the Act.
Have you any unspent criminal convictions or bind-overs , or
Yes 
NO 
any cautions, warnings or reprimands
If yes, please give details
Having a criminal record will not necessarily bar you from volunteering with the Trust, however failure to do reveal
information relating to any convictions could lead to withdrawal of volunteer placement.
CRB Disclosure Procedure
As part of our ongoing commitment to the continued safety of our patients, visitors and staff, all successful candidates will
be required to undergo a Disclosure check, through the Criminal Records Bureau.
Data Protection
The Trust will hold securely all personal information it collects about volunteers & respect their privacy. We only ask for
necessary information, keep it securely & will only pass on details without your consent when legally obliged to do so. The
Trust is registered with the Information Commissioner who is responsible for the Data Protection Act (1998).
Equal Opportunities Monitoring
Nottinghamshire Healthcare NHS Trust is committed to eliminating discrimination. It is the Trust's aim to select on the basis
of suitability and capability and to ensure all candidates are treated solely on grounds of merit. Please assist us by
completing the details requested below.
I would describe my ethnic origin as follows:
Asian or British
Mixed
Other Ethnic Group
 Asian
 White & Asian
 Chinese
 Bangladeshi
 White & Black African
 Any other ethnic group
 Indian
 White & Black Caribbean
 Pakistani
 Any other mixed background
White
 Any other Asian background
 I do not wish to disclose my
 Black or Black British
 British
ethnic origin
 African
 Irish
 Caribbean
 Any other White background
 Any other Black background
Do you consider yourself to have a disability?
 Yes
 No
 I do not wish to disclose this information
If yes, what is the nature of your disability?
Sensory
Mobility
If yes, do you need special arrangements to
enable you to attend for interview?
Mental health
 Yes
 No
Physical co-ordination
Learning Disability Other
If so, please give details below
Declaration
I certify that the above information is, to the best of my knowledge, correct.
Signed……………………………………………. Date………………………………………………
Completed forms should be returned to
The Voluntary Services Department
Duncan Macmillan House
Porcester Road
Nottingham
NG6 3AA
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