Volunteer Application Form

Name

First

Last

Contact Number

E-mail Address

Address

Post Code

Emergency Contact Details (Name)

First

Last

Emergency Contact Contact Number

Please tell us your Status (Are you)

A Student
Employed or Self-Employed
Other

Do you have the right to work/volunteer in the UK

Yes
No

During which hours are you available for volunteer assignments

Are you interested in regular volunteering or ad hoc volunteering

Ad-hoc
Regular

Please indicate your availability

Mornings
Afternoons
All Day

Please state which days you would be available

Frequency

Weekly
Monthly
Flexible

Tell us in which areas you are interested in volunteering

What attracted you to volunteering with us?

What would you like to achieve from volunteering with us?

Do you have experience working with individuals who have sustained an ABI?

1 Do Tell

Tell us about any previous volunteering experience you may have

What skills or experience do you have that would benefit Headway Sussex?

What qualities do you feel you could bring to a voluntary position?

Tell us about your interests/leisure activities

Do you have any additional needs we should be aware of?

Do you have any unspent criminal convictions?

Yes
No

If yes please provide details in confidence

References: Referee 1 Name & Relationship (line manager / employer / etc)

References: Referee 1 Email Address

References: Referee 1 Contact Number

References: Referee 1 Address

References: Referee 2 Name & Relationship (not family members)

References: Referee 2 Email Address

References: Referee 2 Contact Number

References: Referee 2 Address

Diversity: Age

Diversity: Gender

Female
Male
Non-binary
Prefer not to say

Diversity: Ethnicity

Diversity: Religion

Diversity: Disability

Yes
No

Agreement and Signature: Name printed

First

Last

Data Protection and Consent

I would like to receive current news and updates from Headway Sussex by email
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.
Your details will not be passed onto any third parties.
Headway Sussex is committed to safe, fair and inclusive volunteering. We welcome applications from people of all backgrounds and provide equal opportunities regardless of age, disability, gender identity or expression, marital or civil partnership status, pregnancy or maternity, race, religion or belief, sex, or sexual orientation.