Retail Volunteering Application Form

Hospice at home team - Katharine House Hospice

RETAIL VOLUNTEER APPLICATION FORM

Thank you for your interest and support

Please complete and return to the Shop Manager at your chosen/preferred Katharine House shop.

    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:

    Employment/Interest

    Present/Previous Employment: (if applicable):

    Briefly summarise your duties/responsibilities

    Hours worked

    Have you done any voluntary work before ? If so, please give brief details:

    Please indicate if you have qualifications, experience or specialist knowledge of any of the areas below:

    Other (please detail)

    GENERAL

    Do you have any support needs?

    YesNo

    Please give brief details below or if you prefer to have a confidential discussion, please contact the Head of Human Resources on 01785 254645

    REFERENCE

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

    Name

    Adress

    Postcode

    Telephone

    Email

    Name

    Adress

    Postcode

    Telephone

    Email

    Availability

    In order to allow us to benefit from your support in the most convenient way for you, please indicate your availability/preferred days/times below (please note this is not a commitment to these days/times):

    Monday

    AMPM

    Tuesday

    AMPM

    Wednesday

    AMPM

    Thursday

    AMPM

    Friday

    AMPM

    Saturday

    AMPM

    Sunday

    AMPM

    Data Protection

    Katharine House Retail Ltd. will keep a record of your personal details, in connection with your volunteer application. By
    entering into this agreement you consent to the processing of your personal details by us for the sole purpose of
    managing our volunteer services. If you are in agreement with this, please tick the box.

    Signed

    Date