Part 1 Personal Information & Contact Details

Title
Mr Mrs Miss
Other
First Name
Surname
Address
Telephone Number Home: Mobile:
Email Address
Date of Birth
Occupation
Next of in
Name:
Telephone Number:
!ole "ou are
appl"in# for
(f known)
Part 2 About Yourself
$or% Histor" &paid or unpaid' co(erin# the past )(e "ears:
From To Or#anisation Name *osition Held
DO +O, HA-E AN+ *E!SONA. E/*E!0EN1E OF 1AN1E! O! BE!EA-EMENT2
+ES 3 NO
*lease note that for some roles 4e do not ta%e (olunteers 4ho are currentl" or
recentl" &4ithin the last 5 "ears' a6ected b" cancer or berea(ement issues7 0f
"ou ha(e recent experience of either "ou can re#ister as a Mulberr" Mate 3 TM1
Fundraiser7
0f +ES please pro(ide details:
The Mulberry Centre
Volunteer Application Form
___________________________________________________________________________________________________
___________________________________________________________________________________________________
__
!ele(ant Trainin# and 8uali)cations &please continue on a separate sheet
if necessar"'
Dates $here Trained 8uali)cation 9ained
*lease tell us about "our hobbies3interests &e7#7 #olf: music: #ardenin#
etc7'
We have a varety of vounteerng opportuntes under the man headngs sted beow.
Pease ndcate whch eds you are have an nterest/experence n:
Admnstraton Fundrasng
Compementary Therapes Leaet / coectng box dstrbuton
Wecomng Supportng The Muberry Centre (TMC) events
Befrendng Runnng your own events n ad of TMC e.g.
cohee mornng
Drvng Assstng wth stas and fars
Marketng Sourcng Rame Przes
Pants/Gardenng Seng Rame tckets
Sponsored Run Seng Muberry Merchandse
Sponsored Cyce Cake Bakng
A-A0.AB0.0T+: Pease note:
We woud apprecate a mnmum commtment of sx months
Some admn/fundrasng roes are exbe and do not requre a xed day
*lease indicate 4ith a tic% 4hich da"s "ou are currentl" a(ailable7
0f "ou are a(ailable to
help at short notice
&e7#7 to pro(ide co(er
in the e(ent of
sic%ness3lea(e': please
tic% this box
If you are appyng to be a Vounteer Drver pease compete the foowng secton:
(Pease note: If appyng to become a Vounteer Drver the foowng documents must be
provded at ntervew)
1. Drvng Lcence
2. Current MOT Certcate
3. Current Insurance Document
D!0-0N9 .01EN1E N,MBE! 0NS,!AN1E 1OM*AN+:
MON T,ES $EDS TH,! F!0 SAT S,N
AM
*M
E(eni
n#
An" endorsements on this
licence2
0s "our 0nsurance compan" a4are that "ou plan to
(olunteer2
!OADS0DE !ES1,E MEMBE!SH0*2
+es 3 No
!oadside !escue Or#anisation 1ompan" and
Membership number:
Part 3 - References:
Pease provde the names of two peope who can provde a reference for you. (They MUST
NOT be members of your famy or frends and one must be from a professona n your
ed for certan roes).
NAME NAME
ADD!ESS ADD!ESS
;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;; ;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;
;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;; ;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;
TE. NO TE. NO
EMA0. EMA0.
!E.AT0ONSH0* TO +O, !E.AT0ONSH0* TO +O,

!EHAB0.0TAT0ON OF OFFENDE!S
Due to the nature of the work for whch you are appyng, ths post s exempt from the provsons of
Secton 4(2) of the Rehabtaton of Ohenders Act, 1974, by vrtue of the Rehabtaton of Ohenders
Act, 1974, (Exemptons) Order 1975. Appcants are; therefore, not entted to wthhod nformaton
about convctons, whch for other purposes are spent under the provsons of the Act, and, n the
event of acceptance for vountary work, faure to dscose such convctons coud resut n
termnaton of vountary work. Any nformaton gven w be treated condentay and w be
consdered ony n reaton to an appcaton for postons to whch the Order appes.
HAVE YOU HAD ANY CONVICTIONS YES/NO
If YES, pease specfy
I decare that the nformaton gven above s correct. I understand that n the event of any
of ths nformaton beng ncorrect t may resut n termnaton of my vountary work
agreement.
S09NED_________________________________________________ DATE____________________
Many tan!s for com"letin# tis $olunteer A""lication %orm
*.EASE !ET,!N TO:
Adrienne To4nsend
Macmillan Ser(ices and -olunteer 1oordinator
The Mulberr" 1entre
$M,H
T4ic%enham !oad: 0sle4orth
M0DD.ESE/ T$< =AF
or alternati(el" (ia email to
adrienne7to4nsend>themulberr"centre7co7u%