Apply to Volunteer

Name

Address

Email

Home Telephone

Mobile

Preferred Contact Method

Email

Home Telephone

Mobile

Post

Referees

Please name two people who we can contact for references: This can include one reference from a close friend or relative and one from a current or former employer, a teacher, professional, or person in authority. If you have a medical condition and/or impairment which you think may affect your volunteering, please provide a referee who we can contact who has input into your care e.g. GP or Therapist.

First Referee

Name

Address

Email

Contact Number

In what capacity do they know you?

Second Referee

Name

Address

Email

Contact Number

In what capacity do they know you?

Declarations

Do you have any criminal convictions?

Yes

No

If yes, please give details below, this should exclude any spent convictions under Section 4 (2) of the Rehabilitation of Offenders Act 1974, unless the role for which you are applying involves working with vulnerable adults or children in which case cautions, bindovers, pending prosecutions, spent or unspent convictions must be declared.

For some of our volunteering roles, that involve working closely with children, we may require further checks including Access NI

Are you happy for these checks to take palce?

Yes

No

The information provided on this form will be treated confidentially, in accordance with Cancer Fund for Children’s data protection policy.

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Volunteer Role

Referees

Declarations