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Please state which volunteer role(s) you are applying for:

Personal Details

* Indicates required field

Your Name *:

Address *:

Postcode *:

Date of Birth:

Date *:

Month *:

Year *:

Contact Details

Phone Number *:

Email *:

Confirm Email *:

Emergency contact. Name, relationship to you and contact number:

Relevant experience

Please tell us about any relevant voluntary or paid experience that you have and why you wish to volunteer for Changing Lives:

Are you currently a client of Changing Lives?
YesNo

Have you ever been a client of Changing Lives?
YesNo

References

Please provide details of someone who has known you for at least a year (this could be a previous employer or work colleague, teacher, doctor etc.). Please do not use relatives as references.

Referee 1

Address 1

Postcode

Phone 1

Email 1

Referee 2

Address 2

Postcode

Phone 2

Email 2

What is your relationship to the referees?

Referee 1

Referee 2

I am available on the following basis: (Please detail hours/days per week you can offer.)

Day of the week	Morning (Please specify times)	Afternoon (Please specify times)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Additional information

Please detail any needs that you have and would like us to take into account: (e.g. Disability, caring responsibilities etc. This information will be treated as strictly confidential)

Rehabilitation of Offenders Act 1974 - Declaration

All information given will be completely confidential.

Because of the nature of our work, we need to know:

Do you have criminal record*?
YesNo

*NB. This includes 'spent' convictions as defined by the Rehabilitation of Offenders Act 1974. We undertake Police Checks for all volunteers who are likely to come into contact with Changing Lives’ clients.

If the answer is YES, we may wish to discuss it with you. It will not necessarily prevent you from becoming a volunteer. If you wish, you may give further details below:

How did you find out about volunteering for Changing Lives? i.e social media, jobcentre, website

Would you occasionally like to receive news about volunteering at Changing Lives via email?
YesNo

Declaration *

I declare that the information that is recorded in this form is accurate and true.
I understand that providing misleading or false information may disqualify me from undertaking volunteering activity for Changing Lives. I also understand that any offer of placement and subsequent volunteering is subject to satisfactory references and satisfactory disclosure from the Disclosure and Barring Service at the appropriate level.

Apply to volunteer at Changing Lives

Personal Details

Date of Birth:

Contact Details

Relevant experience

References

Additional information

Rehabilitation of Offenders Act 1974 - Declaration

Declaration *

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