Moments Coffee Shop Volunteer Heath Road, Ipswich or Stowmarket HiddenVacancy Title Personal detailsFirst Name* Middle name Last Name* Address* Street Address* Address Line 2 City* County* AvonBedfordshireBerkshireBuckinghamshireCambridgeshireCheshireClevelandCornwallCumbriaDerbyshireDevonDorsetDurhamEast SussexEssexGloucestershireHampshireHerefordshireHertfordshireIsle of WightKentLancashireLeicestershireLincolnshireLondonMerseysideMiddlesexNorfolkNorthamptonshireNorthumberlandNorth HumbersideNorth YorkshireNottinghamshireOxfordshireRutlandShropshireSomersetSouth HumbersideSouth YorkshireStaffordshireSuffolkSurreyTyne and WearWarwickshireWest MidlandsWest SussexWest YorkshireWiltshireWorcestershireClwydDyfedGwentGwyneddMid GlamorganPowysSouth GlamorganWest GlamorganAberdeenshireAngusArgyllAyrshireBanffshireBerwickshireButeCaithnessClackmannanshireDumfriesshireDunbartonshireEast LothianFifeInverness-shireKincardineshireKinross-shireKirkcudbrightshireLanarkshireMidlothianMorayNairnshireOrkneyPeeblesshirePerthshireRenfrewshireRoss-shireRoxburghshireSelkirkshireShetlandStirlingshireSutherlandWest LothianWigtownshireAntrimArmaghDownFermanaghLondonderryTyrone 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 Which coffee shop do you prefer? Heath Road Ipswich Stowmarket How did you hear about this vacancy? Hospice website Local press Word of mouth Social media Volunteer Suffolk Other If other, please state 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 a satisfactory reference has been received. Please try to supply email addresses as this will speed up the application. Reference oneName* Job Title Organisation Address Telephone Email Reference twoName* 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