Please forward a copy of this form to:
<insert name>
If the volunteer is recruited, please forward a copy of this
application to joe_pearshouse@shelter.org.uk
Volunteer Role/Area of Interest:
Personal Details
First name
Surname
Address for correspondence
Telephone number
Email address
Is there any time you are not available for an informal
meeting?
If successful, which date could you start?
References
Please give details of two people who have known you for at least a year. This should be a current or former
tutor/employer or some other professional. Please do not use relatives as a referee.
Name
Address for correspondence
Relationship to you
Telephone number
Email address
Name
Relationship to you
Telephone number
Email address
Address for correspondence
Availability
Please detail hours/days per week you can offer. Please note we do not have roles available outside of office hours.
Day of the week
Morning (specify hours)
Afternoon (specify hours)
Monday
Tuesday
Wednesday
Thursday
Friday
Relevant Experience
Please tell us about any relevant voluntary, paid or educational experience that you have. Please include details of any
IT skills and/or experience of working with the public.
Why would you like to volunteer for Shelter?
Volunteering and Immigration Status
It is important that individual volunteers take responsibility for ensuring they are allowed to volunteer because they could
jeopardise their immigration status. If in doubt they should contact the UK Border Agency for advice.
Are you allowed to volunteer in the UK?
Yes / No
Where did you see this role advertised?
Please Specify:
Shelter Service
Website
Word of Mouth
Other
Conflict of Interest
Please sign to confirm you have no known conflicts of interest in partaking in volunteering / work experience. Examples
of conflicts could include being a landlord or working for a social or private housing provider or having personal or family
relations who you know are clients of Shelter. Please contact us if you are unclear if there is a conflict.
Signed
Date
Declaration
In accordance with the Data Protection Act 1998, I give my consent for the information in this form to be processed in
accordance with Shelter policy for the purposes of volunteering. I understand that if I am offered a volunteering role, this
application form will become part of my personnel file and record. If I am not offered a role it will be stored securely and
confidentially and then destroyed. I certify that the information given on this form is correct to the best of my knowledge. I
understand that should any false statements or omissions be made, a volunteer role may not be offered.
Signed
Date
Safeguarding self-declaration form – volunteers
Safeguarding is a term that describes a framework of help, support and statutory interventions that are designed to
promote the well-being, health, and development of children and adults, including preventing and protecting them from
abuse and neglect. In this regard, Shelter is committed to protecting the health, wellbeing and human rights of those we
support, and enabling them to live free from harm, abuse and neglect.
The purpose of this self-declaration form is to ensure that we understand relevant risks associated with our
responsibilities to safeguard the health, well-being and development of children and adults. We therefore require people
who come into contact with, or handle personal details of, children or vulnerable adults/adults at risk of abuse and/or
neglect (herein ‘adults at risk’) to complete and sign this declaration.
This self-declaration form will be kept for the duration of your volunteering with Shelter and 6 months afterward. Please
note that declaring a conviction will not necessarily prevent you from being considered for volunteering.
1. Has any Social Service Department or the police ever conducted an enquiry or investigation about any allegations or
concerns you may pose an actual or potential risk to children, young people or adults? YES/ NO (if YES, please provide
details below)
2. Have you ever been convicted of any offence relating to children, young people or adults that is unspent? YES/ NO (if
YES, please provide details below)
3. Have you ever been the subject of disciplinary procedures or been asked to leave employment or voluntary activity due
to inappropriate behaviour towards a child, young person or adult at risk? YES/ NO (if YES, please provide details below)
4. Are there any other matters which may inhibit or otherwise affect your ability to work with children, young people or
adults at risk? YES/ NO If yes, please specify.
5. Please declare any unspent convictions or any criminal offence investigations or procedures you are currently subject
to below:
6. I confirm I understand any action which places a young person or adult at risk of abuse/neglect, or could lead to placing
myself or Shelter in a potentially compromising situation, such as meeting a young person alone at their home, or making,
or responding to, an attempt at inappropriate contact could lead to the immediate termination of my appointment. YES/
NO
This declaration must be signed and returned to joe_pearshouse@shelter.org.uk prior to commencing any volunteering
with Shelter which would involve contact with children, young people, adults at risk or their personal details.
I confirm that the above information given by me is correct and that I consent to my personal data being processed and
kept for the purpose described above in accordance with the Data Protection Act 1998
Name (CAPS) _____________________________
Signature ________________________________________ Date _____________________
Proposed Volunteer role __________________________
Office / Team _______________________________