Application for Volunteering

Volunteers Katharine House Hospice

Application for Volunteering

Katharine House Hospice is an equal opportunities organisation

Please complete our online form, which, once completed and upon pressing ‘send’ will be received and processed by the Voluntary Services team.

    * Please choose your area of interest:

    * Title:

    * Forename/s:

    * Surname:

    * Address:

    * Postcode:

    Are you under 18 ?

    YesNo

    * Tel. No: Home/Work:

    Mobile:

    Email:

    Preferred method of contact:

    EmailPostTelephone

    * Emergency Contact: Name:

    * Relationship:

    * Tel. No:

    GENERAL

    Do you have any support needs?

    YesNo

    * Please give brief details

    Have you experienced a close bereavement within the last twelve months?

    YesNo

    Please give brief details

    REFERENCE

    Please give the name and address of two referees, whom we may approach for a reference, excluding relatives:

    * Name

    * Address

    * Postcode

    * Telephone

    * Email

    * Name

    * Address

    * Postcode

    * Telephone

    * Email

    CONVICTIONS

    Katharine House Hospice is registered with the Care Quality Commission and must seek disclosures from the Disclosure and Barring Service (formerly known as Criminal Records Bureau) for some volunteer positions. Katharine House has a strong Rehabilitation of Offenders policy. The Disclosure will reveal spent convictions. Failure to accurately answer the question below may lead to your application being declined, but the answer ‘Yes’ will not necessarily prevent you from volunteering

    The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are 'protected' and are not subject to disclosure to employers, and cannot be taken into account. Guidance and criteria on the filtering of these cautions and convictions can be found at the Disclosure and Barring Service website.

    Have you been/or are you currently the subject of any police investigation or conviction in this or any other country?

    YesNo

    If Yes please give summary details below, or contact the Head of HR on 01785 254645 if you would prefer a confidential discussion

    Data Protection

    Katharine House Hospice takes its responsibility to protect your privacy and personal data seriously. Applicants completing this form will be giving consent for their personal data to be stored manually in personnel files and in our computer systems. The data is held solely for the purposes of volunteer recruitment and managing our volunteer services.

    There are a range of information notices available on our web-site at www.khhospice.org.uk/we-value-your-privacy

    * Please type your name here to give your consent:

    * Date