‘Si senior’
(over 50’s international
exchange programme)
APPLICATION FOR VOLUNTEER ROLE
We welcome applications from all sections of the community and from people with diverse
experience and backgrounds.
PERSONAL DETAILS
Post Applied for : ________________________________________________________________
Name : ________________________________________________________________________
Address : ______________________________________________________________________
__________________________________________________Postcode: ____________________
Contact Number(s): ______________________________________________________________
Email address: __________________________________________________________________
Do you have any support needs that we should be aware of? _____________________________
_______________________________________________________________________________
Why do you want to volunteer?
What prevous volunteering experience do you have?
Birmingham Voluntary Service Council 138 Digbeth Birmingham B5 6DR
Tel: 0121 678 8839 Email: volunteerbirmingham@bvsc.org
The points below are the skills and abilities required.
Next to each point please give us examples of how your skills/abilities and previous
experience would support you to carry out the volunteer role.
An interest in volunteering and basic knowledge
of the voluntary sector
Customer service skills
Effective working within a team
Flexibility and willingness to learn
Good comuincation skills and a willingness to
learn basic Spanish
Basic ICT skills
Ability to organise self and workload
Experience of or willingness to try new
experiences and embrace different cultures
Prepared to travel internationally (this must
include having a current valid passport and
being fit to travel
To be out of the country and away for home for a
period of 3 weeks
Commited to volunteering time for whole
programme March –june
Ability to access the appropriate level of travel
insurance
Birmingham Voluntary Service Council 138 Digbeth Birmingham B5 6DR
Tel: 0121 678 8839 Email: volunteerbirmingham@bvsc.org
REFERENCES
Please give the names and address of two referees (for example, a friend of the family, work
colleague, teacher or voluntary work organiser. They cannot be a relative.)
Name 1)
Name 2)
Address
Address
Post Code
Post Code
Telephone Number
Telephone Number
Email Address
Email Address
Relationship to You
Relationship to You
How did you hear about this voluntary opportunity?
Signature:…………………………………........
Date: ………………………………………….
Data Protection Act 1998
Your personal information will be held by BVSC, and will only be used to contact you regarding volunteering.
Some of your personal information (for example age, gender, postcode) may be required by our funders. We
will also use it for monitoring and evaluation to make sure we provide a fair service.
By signing this form, you are consenting to us holding this information, and using it as detailed above.
PREVIOUS CONVICTIONS
Have you been convicted of a criminal offence (other than “spent” convictions under the
Rehabilitation of Offenders Act 1974 (amended).
Yes  No 
If yes, please give details.
If your application is in respect of a position, which involves the supervision of, or is otherwise
connected with occupations that are exempt from the Rehabilitation of Offenders Act 1974
(amended) you are required to declare any convictions for criminal offences. You may provide
details here or submit them on a separate sheet in a sealed envelope, marked “Confidential”.
Birmingham Voluntary Service Council 138 Digbeth Birmingham B5 6DR
Tel: 0121 678 8839 Email: volunteerbirmingham@bvsc.org
Equal Opportunities Monitoring
Birmingham Voluntary Service Council is committed to equal opportunities. To make sure that that
volunteers are selected and treated on the basis of their individual merits and abilities, it would help
us if you would provide the information requested below. We are also required to monitor this
information under the Equalities Act 2010, and for our funders.
The information below is anonymous and will not be stored with any identifying information about
you. All details are held in accordance with the Data Protection Act 1998.
ETHNICITY
Please state what you consider your ethnic origin to be.
White
 English/Welsh/Scottish/Northern Irish/British
 Irish
 Gypsy or Irish Traveller
 Other (please write below)
___________________________________________________
Black/Black British
 African
 Caribbean
 Other (please write below)
___________________________________________________
Asian/Asian British
 Indian
 Pakistani
 Other (please write below)
 Bangladeshi
 Chinese
___________________________________________________
Other ethnic group
 Arab
 Other (please write below)
___________________________________________________
Mixed/Multiple Ethnic Groups
 White & Black Caribbean
 Asian & Black
 White & Black African
 Other (please write below)
 White & Asian
___________________________________________________
 Rather Not Say
Birmingham Voluntary Service Council 138 Digbeth Birmingham B5 6DR
Tel: 0121 678 8839 Email: volunteerbirmingham@bvsc.org
DISABILITY
Do you consider yourself to have a disability?
 Yes
 No
 Rather Not Say
ORIENTATION
 Heterosexual
 Rather Not Say
 Gay
 Lesbian
 Bisexual
GENDER IDENTITY
Male
Female
Transgender
 F to M
 M to F
 Intersex person
 Rather Not Say
FAITH
 Christian (including Church of England, Catholic, Protestant and all other Christian denominations)
 Buddhist
 Sikh
 Hindu
 Jewish
 Muslim
 No religion
 Rather Not Say
 Other (please write below)
___________________________________________________
AGE
 16-19
 50-54
 20-29 55-59
30-34
 60-64
 35-39
 65-70
 40-44
 70+
 45-49
 Rather Not Say
Birmingham Voluntary Service Council 138 Digbeth Birmingham B5 6DR
Tel: 0121 678 8839 Email: volunteerbirmingham@bvsc.org