Volunteer registration page - St Elizabeth Hospice

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Vacancy Title

Personal details

First Name*

Middle name

Last Name*

Address*

Street Address* Address Line 2 City* County* Postcode*

Telephone Number (home)

Telephone Number (mobile)

What time of day would you like us to call you?

Email*

Enter Email Confirm Email

Date of Birth (if you are under 18)

Preferred Pronouns

He/Him
She/Her
They/Them

How did you hear about this vacancy?

Hospice website
Local press
Word of mouth
Social media
Volunteer Suffolk
Other

If other, please state

Are you interested in a career in health and social care? By ticking this box, you consent to one of our team contacting you about our Volunteer to Career pathway

Yes

Do you require a work permit to work in the UK?

Yes
No

Do you have a family member that works for the Hospice?

Yes
No

If Yes: Where do they work?*

What is their name & job title?*

Do you hold a current UK Driving Licence?

Yes
No

Have you any driving convictions or endorsements?

Yes
No

If YES please specify below*

Do you consider yourself to have any disabilities which may affect your application?

Yes
No

If yes*

Please describe such disabilities below, providing details of:- Any reasonable adjustments which you feel should be made to the recruitment process to assist you in your application for the job. Any reasonable adjustments which you feel should be made to the job itself which would enable you to carry out the job.

Personal Statement

Please use this section to evidence how you meet the criteria within the volunteer role profile. Please give examples from your paid or unpaid work or any other relevant activities. A decision to shortlist can only be based on the information provided within this personal statement.

Previous experience*

References

Please supply contact details of two referees who must be over 18, not a relative and have been known to you for at least two years. Your referee can be a neighbour, friend or colleague (past or present). We will contact referees as part of the application process, it is hospice policy not to offer a formal start date until two satisfactory references have been received. We will request a professional reference for certain roles.

Reference one

Name*

Job Title

Organisation

Address

Telephone

Email

Reference two

Name*

Job Title

Organisation

Address

Telephone

Email

Criminal convictions/Probity declaration

Because of the nature of the work undertaken by St Elizabeth Hospice, we require you to answer the following questions. In the event of employment, any failure to disclose such convictions could result disciplinary action or dismissal by the Hospice. Any information given will be completely confidential.

Do you have any convictions, cautions, reprimands or final warnings that are not “protected” as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013) by SI 2013 1198 as set out at http://www.legislation.gov.uk/uksi/2013/1198/pdfs/uksi_20131198_en.pdf.

Convictions?

Yes
No

Have you ever been disqualified from the practice of a profession or required to practise under specific limitations?

Disqualified?

Yes
No

Are you the subject of any current investigation or proceedings by a professional or regulatory body in the UK or any other country?

Subject of any current investigation?

Yes
No

Has your employment or contract ever been terminated or suspended – in the UK or abroad – on grounds relating to your fitness to practise (conduct or performance)?

Has your employment or contract ever been terminated or suspended

Yes
No

Data Protection Act 1998 and General Data Protection Regulations 2018

This application form has been designed to provide us with sufficient basic information to carry out a preliminary assessment of your suitability for the post. The information you supply in this form is confidential and will only be used by those involved in the appointment in line with the Data Protection Act 1998 and the General Data Protection Regulations 2018. For further information please refer to the GDPR information for job applicants and the hospice’s privacy notice which can be found on the website.

Declaration

By ticking below, I confirm that the information given on this form is, to the best of my knowledge, complete and correct. I understand that any incorrect or incomplete information may lead to my application being refused. I confirm that I am legally eligible for a volunteering role in the UK (if you are eligible to work in the UK, you are eligible to volunteer). I understand that if I am accepted as a volunteer, my details will be held on a secure database for St Elizabeth Hospice use only..

Declaration*

I Confirm

CAPTCHA

Community Care Unit Volunteer Health Care Assistants

Personal details

Personal Statement

References

Criminal convictions/Probity declaration

Declaration

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