YCP Volunteer Application Form

CONFIDENTIAL
Mr. Mrs. Miss. Ms. (circle one) Gender: Male Female (circle one) .. . .. e-mail: .. Evening: . Mobile: . .. . ..

First name: Surname: Address: Post Code Telephone: Daytime: E-mail: mail:

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
the following that Interest you: Administration Children and Young People Disability Employee and Group Volunteering Languages Marketing and PR and Media Trusteeship and Committee Work Computers, Technology and Website

Type of Activity - Please tick any (3) of

the following that Interest you: Caring Teaching Fundraising Local Events Mentoring Training and Coaching Befriending and Buddying Under 16 Volunteering

Please tick each box when you could be available as a volunteer. Mon AM PM EVE
Full Time or Main Occupation (if applicable): applicable) Date Appointed:

Tues

Wed

Thu

Fri

Sat

Sun

Post Held: Name and Address of Employer:

Post Code:
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Please give brief details of any previous voluntary work, paid work experience, qualifications, skills etc. Please include any youth work training or qualification; course details and dates.(Please continue on a separate sheet if necessary)

Do you hold a clean Driving License?

Yes

No

(Please Circle)

Briefly outline any personal interests skills and/or experience that you feel may be relevant to this post.

Please state why you are interested in becoming a Voluntary Youth Worker.

For this post you will be expected to have an understanding and commitment to equal opportunities and to work in a way that challenges discrimination. Please state your understanding of equal opportunities.

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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:

Is there anything else you would like to tell us about yourself?

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 Crossroads Care - South Thames might apply for a reference.
Name Address Name Address

Telephone No Mobile Occupation

Telephone No Mobile 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: YCP Volunteer Applications, Crossroads Care - South Thames, Woodlawns, 16 Leigham Court Road, Streatham, SW16 2PJ. Please mark the envelope Private and Confidential.

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