Personal Details
Name:
Where did you hear about the volunteering opportunity?
Why are you interested in volunteering?
Please tick all that apply.
To build CV and help find workGain skills and experienceConnect with othersHave free time to giveGive back to the communitySupport and listen to peopleUse experience to benefit individuals and Conwy MindFeel valued and part of a team
Please give details:
What can you bring to Conwy Mind and volunteering?
E.g. Experience and skills, hobbies and interests, supportive nature, enthusiasm etc.
What might get in the way of you volunteering?
E.g. Lack of time, family commitments, lack of transport, low confidence etc.
Your availability
What days and times would best suit you and how often would you be able to volunteer?
Support and health needs
Do you have any disabilities, health needs or extra support needs that we should be aware of when organising your volunteering?
YesNo
If yes, please give details to help us support you in your volunteering.
Have you any lived experience of mental health? (eg yourself, friends, family)
Do you speak any languages?
If yes please give details:
Declaration of criminal records and disqualifications
Do you have any unspent criminal convictions
YesNo
If yes, please state date and type of conviction
Character Reference
If possible these should be current/past employers/tutors or places of volunteering.
Data protection
The data we gather and hold is managed in accordance with the data protection act (1998). We will not disclose or share personal information supplied by you with any third party without your consent. The information provided on this form will only be disclosed to those who have a legitimate interest to see it.
I understand and agree that data contained in this application form will be used for volunteer recruitment purposes and will be held on a computer database.
YesNo
I also agree to Conwy Mind holding this information on our secure database.
YesNo
Following the completion of your volunteering role the data will be kept for 1 year.
Declaration
I confirm that the information I have given is correct and complete and that any false statements or omissions may result in my role being terminated.
Name:
Date:
