Volunteer Application Form

CONFIDENTIAL

Mr. Mrs. Miss. Ms. (circle one) Gender: Male Female (circle one)

First name: ……………………………………………………………………………………………..

Surname: ……………………………………………………………………………………………….

Address: ………………………………………………………………………………………………..
……………………………………………………………….Post Code: …………………

Telephone: Daytime: ………………………………….. Evening: .…………….………………….

E-mail: ………………………………………………………… Mobile: ……………………………..
Please take a few minutes to look through the following lists. The Areas of Interest and
the Activities that you choose help us to match you with volunteering opportunities.

Areas of Interest - Please tick any (3) of Type of Activity - Please tick any (3) of
the following that Interest you: the following that Interest you:
Administration Befriending and Buddying
Children and Youth Caring
Disability Computers, Technology and Website
Employee and Group Volunteering Fundraising
Languages Local Events
Marketing and PR and Media Mentoring
National and International Events Teaching, Training and Coaching
Trusteeship and Committee Work Under 16 Volunteering

Please give brief details of any previous voluntary work, paid work experience,
qualifications, skills etc. (Please continue on a separate sheet if necessary)

Please tick each box when you could be available as a volunteer.

Mon Tues Wed Thu Fri Sat Sun

AM
PM
EVE

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Have you ever been convicted of any offence? Yes  No 
(If the voluntary work involves helping with children/young people/vulnerable adults, all criminal
offences must be declared and are exempt from the provision of the Rehabilitation of Offenders Act
1974)
If YES, please give details:

Which age group are you in? (tick one) What is your current employment
status? (tick one)

15-18 Employed
19-25 Non employed
26-29 Houseperson
30-34 Retired
35-39 Student
40-44 Unable to work
45-49 Unemployed
50-54
55-59
60-64
Over 65
Under 15

Which ethnic group do you feel you belong in? (tick one)
White British Indian
White British (English) Pakistani
White British (Scottish) Bangladeshi
White British (Welsh) Other Asian background
White Irish Black Caribbean
Other White background Black African
White & Black Caribbean Other Black background
White & Black African Chinese
White & Asian Any other background
Other Mixed background
Is there anything else you would like to tell us about yourself? (Please continue on a
separate sheet if necessary)

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References: Name and address of two responsible people who have known you for
over two years and are not members of your family, to whom we might apply for a
reference.

Name …………………………………….. Name ……………………………………..

Address ………………………………….. Address …………………………………..

…………………………………………….. ……………………………………………..

…………………………………………….. ……………………………………………..

Telephone No …………………………… Telephone No ……………………………

Occupation ……………………………… Occupation ………………………………

Data Protection:
These records are confidential to Crossroads Care - South Thames. You are entitled to inspect any
record we keep about you. No information will be passed on without your consent to a third party.

Signature: ……………………………………… Date: ………………………………………

Please return your form to: Volunteer Applications, Crossroads Care - South Thames,
Vestry Hall, London Rd, CR4 3UD. Please mark the envelope Private and Confidential

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 A few details about Crossroads Care – South Thames

Crossroads Care - South Thames promotes, offers, supports and delivers high
quality services for carers and people with care needs.

Crossroads Care - South Thames is a registered Charity and Company Limited

by guarantee. We comply with all current legal requirements and have
achieved Croquet Level 3 (a National Association Quality Audit Tool). We have
recently been awarded both the Investors in People Award as well as the
Investors in Volunteers Award. We recently received a very positive report
from the Care Quality Commission (CQC) with whom we are registered.

Crossroads Care provides paid fully-trained care support workers to provide

respite care in the home to adults with physical or learning difficulties, older
people those with mental health issues and children. We also provide a Direct
Care (self referred) service to clients in the Merton, Lambeth, Wandsworth and
Sutton area and two Saturday Clubs, one for children on the autistic spectrum,
the other for older, disabled children, as well as a term-time After-School
Club. We also run a popular Young Carer’s Project, within the Borough of
Lambeth.

All of our staff have induction training, which includes first aid, moving and
handling, abuse awareness, child protection. Staff have opportunities to
undertake NVQ2/3 training. Childcare support workers have specialist training
to include: sign language, autism, play for children with disabilities, top’s play
and the use of top’s specialist equipment funded by Awards for All. The
scheme holds a large selection of toys for children of all ages and abilities.

A key strength of the organisation is to be able to match the care support

workers with an allocated carer/family and ensure that the, on average,
weekly 3 hour visits are undertaken by the same dedicated worker.

Crossroads Care - South Thames is committed to Equal opportunities. We

endeavour to ensure that the services provided to individuals and their
families/carers are in accordance with the policy provided by the National
Organisation. Appropriate training and support is provided to ensure that
services are developed to meet the needs of all groups in society and that
employment practices are consistent with equal opportunities principals.

We have a number of volunteering opportunities with the organisation, which

we would be happy to discuss with you.

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