Volunteer Personal Information Form

Part 1

Name
Date of Birth
Gender	Male Female (please tick one)
Volunteer Role

Emergency Contact Details

Name	Contact Number

Part 2

Please indicate which days and times you may be available to volunteer

Tick all that are relevant

Morning	Afternoon	Evening
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Have you any current or previous voluntary experience? Please give details

What particular skills, experiences and personal interests do you have which could help you in your volunteer role?

Please let us know if there are any reasons you might be restricted to volunteer on some tasks (such as digging, lifting, carrying etc.) or any health issues we should be aware of (e.g. mental health, eyesight, hearing impairment):

Have you ever been convicted or cautioned in relation to a criminal offence, have you been bound-over, or subject to formal warnings or reprimands or are you at present the subject of any criminal proceedings or police investigation?

Yes	No

Please specify dates of summons, charges, cautions, reprimands, final warnings or convictions, court, nature of offence and sentence or order imposed.

Any information disclosed will be treated sensitively and in confidence and will only be used in deciding a candidate’s suitability for the post

Equality Monitoring

Ethnic Origin (please tick)

White	Mixed	Asian or Asian British	Black or Black British	Other ethnic groups
British	White and Black Caribbean	Indian	Caribbean	Chinese
Irish	White and Black African	Pakistani	African	Other
Other	White and Asian	Bangladeshi	Other
Other

FOR OFFICE USE ONLY

Health and Safety Application Pack for role completed and signed off: Yes	No

Date of Induction
Induction by
Further training
Dates

Council Volunteer Manager Signature