DARLINGTON ASSOCIATION ON DISABILITY
(Registered Charity 518265)

Volunteer Application Form


Title:   ......... 	  Surname : .......................................... 

First name (s) .......................................................
  
Address: ................................................................................

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Post Code:..............................................

Telephone: 

Home................................ 

Work................................ 

Mobile: ............................ 

E mail address: ................................. 

Date of Birth:  .................................  


Please Note:
All volunteer posts are subject to the Rehabilitation of Offenders Act 1974 (Exemptions Order 1975).  In the event of your application being successful you will be asked to complete a Criminal Bureau Disclosure form.  This check will disclose any criminal convictions.  If the post involves working with vulnerable adults or children an enhanced check will be requires. This may reveal other information held by the police.  If you have any criminal convictions please supply details on a separate sheet and return with this application.

DAD has a Code of Practice on the recruitment of ex-offenders and undertakes not to discriminate unfairly against any subject of a disclosure on the basis of convictions or other information revealed.  A copy of DAD’s Code of Practice is available on request.  If you wish to discuss this, or any other matter relating to your application please contact the named person on the covering letter.


Please say why you would like to volunteer for DAD and give details of any experience and personal qualities which you think may be relevant. 

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Please indicate if you have personal experience of disability

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Please indicate which days and times you are available to volunteer
				
Monday	Morning		Afternoon		Evening 

Tuesday 	Morning		Afternoon		Evening 

Wednesday	Morning		Afternoon		Evening 

Thursday	Morning		Afternoon		Evening 

Friday	Morning		Afternoon		Evening 

Saturday	Morning		Afternoon		Evening 

Sunday	Morning		Afternoon		Evening 
			
Do you have access to  transport: 				YES/NO				    

References
Please give details of two people, who can comment on your suitability for voluntary work and state in what capacity - e.g. “present employer”, these people are known to you.

1. Name

Address


Post Code: 

Tel :
              
  

Capacity known:

2. Name

Address




Post Code: 
    

Tel :
              
  

Capacity known:



The details above are to the best of my knowledge a true and complete record.




Please return this completed application form in the enclosed confidential pre paid addressed envelope, together with the equal opportunities monitoring form and a separate sheet (if appropriate) detailing any criminal convictions. 

Donna Gibson
Darlington Association on Disability
20-22 Horsemarket
DARLINGTON 
DL1 5PT 



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Office use only:

Received .................   Refs requested (1)..................... 

                                            (2)..................... 



Shortlisted ............      Refs  received (1)......................

							   (2)...................... 

Interviewed ................    Appointed:  YES/NO Notified:

Notified .............. CRB check sent/ received  .......... Start Date …………….