Any information given on this form is confidential
and covered by the Data Protection Act 1998
Ann Owens Centre
Oak Lane
East Finchley N2 8LT
Direct Tel No: 020 8432 1416
Email: sian.jones@ageukbarnet.org.uk
Volunteer Application Form
Surname:
Title:
Forename:
Any middle name(s):
Address:
Post Code:
Please provide your FULL name, as detailed on your birth certificate
Telephone – Home:
Mobile:
Work*:
Email:
*Can we contact you at work?
Y/N
Date of Birth:
Car driver?:
Y/N
Use of a car?
Y/N
NI Number:
How did you find out about voluntary work with us? e.g. BVSC,
word of mouth, local press, national media, which internet site?
Status (please either tick or use a cross)
Unemployed
Student
Retired
Working part-time
Working full-time
Long term sick/disabled
When and where would you be available
for interview and training? When can you
be contacted by what methods? This is
especially important if you are not
available during our working hours.
Please note if you are still at school and/or under 17 years of age, Age UK Barnet will need to
have the agreement of your guardian and/or school (as appropriate) before placing you. If you,
the volunteer applicant, could be considered to be a vulnerable adult, we may need to consult
with an appropriate professional person who knows you well before proceeding with your
application.
Age UK Barnet is a registered charity (1080458) and company limited by guarantee registered in England and Wales number 3863045.
Registered office: Ann Owens Centre, Oak Lane, East Finchley, London N2 8LT.
In order that we may offer you appropriate support in your volunteer role and do not ask you to
do anything that might put you at risk please advise us of any physical, mental or learning
disabilities, allergies, back injuries, etc. If you prefer to tell us about these issues at a later point
you may do so.
Are there any issues you would like us to be aware of?
Details of the person you would like us to contact in case of an emergency:Name:
Address:
Telephone:
Email:
Relationship to you:
(Completing the following groups below is optional. This assists Age UK Barnet to monitor the
effectiveness of our Equal Opportunities policy and details are strictly for confidential statistical
purposes only)
Ethnic group
Asian British

White British

Japanese

Bangladeshi

Chinese

Other Asian background

Black African

European

Other black background

Black British

Indian

Other dual heritage

Irish

Other ethnic group

Black Caribbean 
Other (please specify): ………………………………………. Do not wish to disclose 
Religious group
Atheist

Hindu

Jewish

Buddhist

Muslim

None

Christian

Jehovah’s Witness

Do not wish to disclose

Other (please specify): ……………………………………………….
November 2014
Page 2 of 9
Please note we will need your bank account details if and when you claim expenses.
There is a separate form for these details.
ALL ABOUT YOUR INTEREST IN VOLUNTEERING
Why you would like to join Age UK Barnet as a volunteer? This information will help us
plan your volunteering experience better.
Please detail any qualifications, interests, skills, experience, interests, and languages.
What days/times would you be available?
How much time do you think you could commit to volunteering per month?
What times will you not be available, e.g. other commitments, holidays etc?
November 2014
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Which of the following activities might you be interested in helping with:
Please tick or put a number in order of interest

The Befriending Service needs volunteers to visit isolated, elderly individuals in
their homes on a regular basis.

Admin volunteers to help with office based jobs as well as some home based tasks.
Filing, telephone, databases, photocopying, envelope stuffing etc.

Digital inclusion volunteers to support older adults learning to use and access
digital technology either in their own homes or in communal settings across the
borough. Skill levels are matched to client needs.

Volunteers are needed at our regular neighbourhood events, held throughout the
borough to make those who attend feel welcome and stimulated through chatting,
games, etc. Helpers to take the register and make tea would also be useful.

Activity volunteers willing to organise or support staff setting up and running
activities for older adults throughout the borough. Games, exercise, discussion
groups, art and craft activities are just some of the activities. Leaders and helpers
are also needed for our wide variety of physical activities and training as a Tai Chi
leader is offered and movement to music.

We need group leaders, drivers and hosts for our Special Interest Groups. Could
you join our driving pool?

The Later Life Planning Team needs volunteers for signposting, form filling,
telephone work and translation both in office based locations and in people’s
homes. For those with commitment and aptitude, training for advice work is also a
possible.

Fundraising volunteers prepared to raise small amounts of money, instigate
community fundraising initiatives or help others with events.

There are also roles for volunteers in community networking, and distributing
information to the public Occasional assistance with such tasks as stuffing
envelopes and distributing leaflets and for those with the necessary skills, data
entry.

The Eat Well Live Well project needs speakers, cooks and helpers to run cookery
classes and healthy eating promotional sessions. We also need a small number of
home visitors for temporary placements with individuals who need practical and
emotional support to improve their eating habits.

Please detail below any specific skills or interests that might be useful to Age UK
Barnet and may lead to further opportunities.
November 2014
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Please supply the name and contact details of two referees
They should not be a family member and at least one should be a current/previous employer,
tutor or volunteer manager. If your circumstances mean that you are unable to provide details
of referees we will be happy to discuss this further with you.
Please note that a full postal address is required (and preferably an email address) as we do
not contact referees by telephone for their reference.
1st Referee
2nd Referee
Name:
Name:
(Mr/Mrs/Miss/Ms
(Mr/Mrs/Miss/Ms
Other______________)
Other______________)
Email:
Email:
Address:
Address:
Tel No:
Tel No:
What is their relationship to you? (e.g.
former employer, friend, neighbour)
What is their relationship to you? (e.g.
former employer, friend, neighbour)
How long have they known you?
How long have they known you?
Data Protection Act 1998
Information on our database is strictly confidential and we do not pass on any personal data
about you to outside organisations and/or individuals without your express personal consent.
The only exception to this might be if there is a crisis and the emergency services need to be
given appropriate information. The data provided on this form will be used by Age UK Barnet
for the purposes of supporting our volunteers – and administering, evaluating and monitoring
the quality of our volunteer management. We shall use the information you have supplied to
us in line with Data Protection Guidelines. We will not contact you about our products, services
and the vital work we do for older people if you have not indicated that we may do so.
Please indicate if you agree that we may keep basic information from this form
on computer and send you information updates about Age UK Barnet.
November 2014
YES / NO
Page 5 of 9
There are certain positions and activities that are eligible for a DBS check. These
positions are included in the Rehabilitation of Offenders Act (ROA) 1974 (Exceptions)
Order 1975 and employers are entitled to ask an exempted question for which the
applicant is required to answer. For positions requiring a DBS check please answer the
following question.
Do you have any convictions, cautions, reprimands or final warnings which
would not be filtered in line with current guidance?
YES / NO
If yes, please give details:
…………………………………………………………………………………………………………..
…………………………………………………………………………………………………………..
The amendment to the Exceptions Order 1975 (2013) provide that certain spent convictions
and cautions are ‘protected’ and are not subject to disclosure to employers, and cannot be
taken into account. Guidance and criteria on the filtering of these cautions and convictions can
be found on the Disclosure and Barring Service website.
https://www.gov.uk/government/publications/dbs-filtering-guidance
We may require a Disclosure and Barring Service check. Do you give your
permission for us to carry out a check?*
YES / NO
Have you had a relevant DBS check for working with vulnerable adults carried
out in the last 3 years and, if so, can you and are you willing to show us a copy
or provide your subscription reference number for the update service?
YES / NO
For voluntary positions that do not require a DBS check, please answer the following
question.
Rehabilitation of Offenders Act 1974
Do you have any unspent convictions, cautions,
reprimands or warnings? Please note that applications
are treated individually and that having any criminal
convictions will NOT necessarily prevent you from
volunteering with Age UK Barnet.
 Yes
 No
If YES please
supply dates and
details on a
separate sheet and
attach to this form.
*Please note Disclosure and Barring Service checks can take up to two months to process, depending
on an individual’s circumstances.
VOLUNTEER DECLARATION
I declare the above information is, to the best of my knowledge, correct.
Signature:
November 2014
Date:
Page 6 of 9
FOR OFFICE USE ONLY
Interviewed by
Date
Volunteer Agreement attached
Signed
Date
Health and Safety Induction attached
Signed
Date
Info letter sent
Interview
Accepted
References taken
References received
Start date
General Induction
Task induction
Other Training Needs
Other Courses attended
End Date
Reason left
November 2014
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FOR OFFICE USE ONLY
Is a DBS check required?
YES / NO
Date DBS clearance form sent
____________
DBS Date of Issue
____________
Certificate No
Date DBS due for renewal
____________
Clear / Not clear
Volunteer registered with the Update Service?
__________________
YES / NO
VOLUNTEER PLACEMENT RECORD
Date _______________ Task _______________________________________
Primary Supervisor _______________________________________________
Notes
VOLUNTEER PLACEMENT RECORD
Date _______________ Task _______________________________________
Primary Supervisor _______________________________________________
Notes
VOLUNTEER PLACEMENT RECORD
Date _______________ Task _______________________________________
Primary Supervisor _______________________________________________
Notes
VOLUNTEER PLACEMENT RECORD
Date _______________ Task _______________________________________
Primary Supervisor _______________________________________________
Notes
November 2014
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FOR OFFICE USE ONLY
NOTES
DATE
November 2014
SIGNED
Page 9 of 9