Promoting Independence
Volunteering Department
42 – 48 Parsloes Avenue, Dagenham, Essex RM9 5NU
Tel: 020 8215 9630 Fax: 020 8215 9702
Email: volunteering@dabd.org.uk Website: www.dabd.org.uk
Branches: Parsloes Avenue, Dagenham - Pembroke Gardens, Dagenham - Ripple Road, Barking - Valence Wood Road, Dagenham
Waltham Forest, The Limes Coach House - Havering, Western Road, Romford
VOLUNTEER APPLICATION FORM
INCLUSIVE OPPORTUNITIES
Personal:
Please write clearly, Personal information provided will be treated in confidence
Title:
(Ms/Mrs/Miss/Mr/Dr etc.)
First Names:
Surname:
Address:
Telephone:
(home)
(mobile)
E-mail Address:
N.I. Number:
Are you required to have a work permit?
If so, do you have a valid permit?
Registered Office: 42 – 48 Parsloes Avenue, Dagenham, Essex RM9 5NU
A registered Charity in England and Wales No. 1023730. A company Limited by Guarantee (England) Reg No. 2800290
Education & Training:
Please give details of education from the age of 13
From
To
School/college/university
Examination & Grade
Date
Please give details of any further qualifications obtained/being undertaken or courses
attended. Include membership of professional bodies and any relevant training attended.
Do you have a current full driving licence?
(yes/no)
Registered Office: 42 – 48 Parsloes Avenue, Dagenham, Essex
2 RM9 5NU
A registered Charity in England and Wales No. 1023730. A company Limited by Guarantee (England) Reg No. 2800290
Present Job or Most Recent Employment
Job Title: Customer Service Assistant
Dates of Employment:
Employment History
Employment Employers
Dates
Name
(From / To)
Job Title & Brief Description of
Duties
Reason for Leaving
Registered Office: 42 – 48 Parsloes Avenue, Dagenham, Essex
3 RM9 5NU
A registered Charity in England and Wales No. 1023730. A company Limited by Guarantee (England) Reg No. 2800290
Suitability for Volunteering work
Please give details of your experience, knowledge, skills or interests and knowledge you have. This
may have been gained from your current or previous jobs, from voluntary work, (e.g. literacy,
numeracy, office admin, IT skills, interpersonal skills). From your hobbies or from working in the home
or in the community (e.g. practical skills, gardening, DIY etc.) and any others you can think of :-
You may continue on a separate piece of paper if necessary
References:
Please provide details of two references, they cannot be family and you must have known them for a
minimum of 2 years. Your volunteering position cannot be taken up until references are received.
(UK Only)
Name & Address of Referee
Phone No. and
e-mail address
Relationship to you
(e.g. previous employer)
Registered Office: 42 – 48 Parsloes Avenue, Dagenham, Essex
4 RM9 5NU
A registered Charity in England and Wales No. 1023730. A company Limited by Guarantee (England) Reg No. 2800290
ADDITIONAL INFORMATION (VOLUNTEERS)
AVAILABILITY
Please give details of when you are available to volunteer (e.g. Mondays – a/m)
_______________________________________________________________________________
REFERRAL DETAILS
How did you hear about DABD (uk)? ________________________
If you were referred to DABD Volunteering
by another person/organisation, please give details. _____________________________
WORK STATUS
DABD (uk) may also be able to support our volunteers with work placement projects and training
schemes. In order for us to assess whether or not you would be eligible to benefit from these
services, please tick the relevant boxes below about your current work status :Are you interested in receiving support to return to
paid employment?
Yes
( )
No
( )
Do you require training?
Yes
( )
No
( )
If yes, please give details ___________________________________________________________
Are you currently employed?
Yes
( )
No
( )
If YES, how many hours do you work each week?
_______________
Do you have the right to work in the UK?
Yes
( )
No
( )
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
(
(
(
(
(
(
(
(
No
No
No
No
No
No
No
No
(
(
(
(
(
(
(
(
Do you think you belong to any of the following groups?
In receipt of Employment Support Allowance?
(formerly Incapacity Benefit)
Economically inactive?
In receipt of Disability Living Allowance (DLA)?
In social housing in Barking & Dagenham?
Single parent or person with other care responsibilities?
Refugee?
Homeless?
Alcohol/substance dependent?
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
________________________
___________________________________________________________
___________________________________________________________
________________ (Please continue on a separate sheet if necessary)
Is there any other information you would like us to know?
Registered Office: 42 – 48 Parsloes Avenue, Dagenham, Essex
5 RM9 5NU
A registered Charity in England and Wales No. 1023730. A company Limited by Guarantee (England) Reg No. 2800290
Declaration of Previous Convictions:
Surname:
First Name:
Title:
(Ms/Mrs/Miss/Mr/Dr etc)
Have you been convicted of any criminal offence?
Yes ( )
No ( )
Please provide details of the conviction(s) recorded against you, i.e. the offence, the date on which
you were convicted and the penalty imposed.
Offence(s)
Date(s) of
conviction
Sentence(s)
Please note that all volunteers who work with DABD (UK) Community Volunteering will be required to
have a Criminal Records Bureau (CRB) Enhanced Disclosure check prior to commencing
volunteering work in the community.
If you have stated on the application form previous convictions, you must now provide the relevant
information relating to those convictions.
The 1974 Rehabilitation of Offenders Act allows an individual who has been convicted of an offence,
in certain circumstances, to treat that conviction as ‘spent’ (as if it had never existed) after a certain
period of time providing that in the meantime they have not been convicted of another serious
offence. The rehabilitation periods are as follows:Sentence
Imprisonment, corrective training or sentence of detention in a
young offenders’ institution for more than six months but not
more than 30 months.
Imprisonment or sentence of detention in a young offenders’
institution for a term not exceeding six months.
A fine or other sentence not expressly covered by the Act.
Order for detention in detention centre.
Absolute discharge
Conditional discharge
Probation
Rehabilitation period
Ten years *
Seven years *
Five years *
Three years *
Six months
One year
Five years *
The rehabilitation periods given above indicated * may be reduced by half for a person under 18
at the time the sentence was passed. (In the case of a probation order the period is two and a
half years from the date of conviction or a period beginning with the date and ending when the
order ends, whichever is longer).
HOWEVER, these posts, given the nature of the work involved, are
exempt from the provisions of the Rehabilitation of Offenders’ Act.
This means that details of any convictions recorded
against you must be given.
Registered Office: 42 – 48 Parsloes Avenue, Dagenham, Essex
6 RM9 5NU
A registered Charity in England and Wales No. 1023730. A company Limited by Guarantee (England) Reg No. 2800290
Promoting Independence
Volunteering Department
42 – 48 Parsloes Avenue, Dagenham, Essex RM9 5NU
Tel: 020 8215 9770 Fax: 020 8215 9702
Email: training@dabd.org.uk Website: www.dabd.org.uk
Branches: Parsloes Avenue, Dagenham - Pembroke Gardens, Dagenham - Ripple Road, Barking - Valence Wood Road, Dagenham
Waltham Forest, The Limes Coach House - Havering, Western Road, Romford
Monitoring:
DABD (uk) is committed to achieving equal opportunities in employment. To help us to monitor the
effectiveness of our equal opportunities policy you are asked to complete the following questions.
This information is strictly confidential and will be used on a statistical basis only (i.e. we will keep a
record of the number of applicants from various ethnic groups for each post advertised).
Are you?
Age:
Male
16 to 25
Female
26 to 40
41 to 60
61 +
How would you describe your ethnic origin? (Please tick one box)
WHITE
BLACK OR BLACK
BRITISH
ASIAN OR ASIAN
BRITISH
MIXED
African
CHINESE OR
OTHER ETHNIC
GROUP
Chinese
British
Indian
Irish
Caribbean
Any other
Pakistani
Any other white
background
Any other black
background
Bangladeshi
White and Black
African
White and Black
Caribbean
White and Asian
Any other Asian
background
Any other mixed
background
Faith/Religion/Belief (Please tick one box)
Christian
Hindu
Muslim
Buddhist
Sikh
Other (Please specify)
Jewish
Sexual and Gender Orientation (Please tick onebox)
Heterosexual
Lesbian
Bisexual
Transgender
Gay man
Other (Please specify)
Registered Office: 42 – 48 Parsloes Avenue, Dagenham, Essex
7 RM9 5NU
A registered Charity in England and Wales No. 1023730. A company Limited by Guarantee (England) Reg No. 2800290
Do you have an impairment of which we should be made aware?
I would describe my disability as:
Physical
Sensory
Mental Health
Learning Disability
Declaration & Consent:
This application form will be part of your volunteering commitment. If
any particulars given by you in this application are found to be false or if
you willfully omit or suppress material facts you are liable to be
dismissed if appointed.
I give DABD(uk) permission to pass on personal details from my
volunteer application form to the prospective volunteer placement
Managers. This is on the understanding that these details will only be
used for contact purposes relating specifically to their screening and
interview processes for potential voluntary positions. All information is
to be treated in the strictest confidence and will not be divulged to any
other organisation or company outside of DABD(uk) without my prior
written consent.
This consent does not absolve DABD(uk) of their legal responsibilities
of protection of my personal information under the Data Protection Act.
I declare to the best of my knowledge the information provided on this
form is correct.
Signed
________________________________________________________
Print Name
_________________________________________________________
Date
_________________________________________________________
Registered Office: 42 – 48 Parsloes Avenue, Dagenham, Essex
8 RM9 5NU
A registered Charity in England and Wales No. 1023730. A company Limited by Guarantee (England) Reg No. 2800290