Volunteer Application Form Volunteer Application Form Step 1 of 6 16% This form is a chance for you to tell us more about you before we arrange to meet you. Please answer the questions as honestly and fully as you can. Please contact us if you need any support or would like to meet us so we can fill in the form with you.About YouName(Required) Gender(Required) Current Address including postcode(Required)Email(Required) Tel Number(Required) Mobile Number(Required) Ethnic Origin(Required) Nationality(Required) Date of Birth(Required) DD slash MM slash YYYY Languages Spoken(Required) How did you hear about Home-Start?(Required) Do you hold a current DBS that has been registered with the update service?(Required) Yes No Will you be using a car to visit Home-Start families?(Required) Yes No Some of our training is accessed through E-Learning. Are you able to complete training using this method?(Required) Yes No Will you need any support to enable you to complete E-Learning?(Required) Yes No Do you have any communication needs or a disability or health condition that might need adjustments to be put in place? Please specify if answer yes(Required) Yes No Comment ReferencesPlease provide details of two people (not a relative) who have known you for at least two years who may be contacted to provide us with a reference – please make sure they are happy to provide a reference for you before you give their details. If you have a current or previous employer or volunteer coordinator we would like you to include them as a referee. Referee 1Referee 2Name(Required) Name(Required) Address(Required)Address(Required)Email(Required) Email(Required) Relationship (e.g. Previous Employer)(Required) Relationship (e.g. Previous Employer)(Required) Why would you like to become a Home-Start volunteerTick as many as you like(Required) To use existing skills To get out of the house / escape boredom As a placement for college / university To be in charge of something To build a new skill To help me get a job / for my CV To feel useful To address a specific problem in the community To feel useful To have fun To make new friends To gain ‘work’ experience To build my self esteem To get recognition Your Skills and ExperienceTell us about any jobs or volunteering you have done, and any parenting/caring experience. Don’t worry if your experience is limited!(Required)We expect volunteers to commit to 2-3 hours every week for a minimum of 12 months, but you can be specific about your availability. Have you any commitments that may affect your volunteering with Home-Start? E.g. part time work, study caring for relatives etc.(Required)What brings you to Home-Start? Home Start Manchester’s values are to be honest, show respect, be just, have integrity and to be kind. Can you give an example of how you demonstrate these in your daily life?(Required) Home-Start volunteers are in a position of trust, visiting families in their own homes and having contact with children and vulnerable adults. Home-Start has a responsibility to ensure that no one becomes a volunteer who would misuse this trust or, because of personal reasons, may not be ready to volunteer with us. Therefore, it is essential that you complete this form. All information provided will be kept confidential.Have you had any contact with Children’s Services / Social Services in connection with children in your care?(Required) Yes No Have you ever been dismissed from any paid or voluntary work?(Required) Yes No Have you ever been convicted of or received a caution for any criminal offence?(Required) Yes No Are there any matters outstanding which may lead to a criminal prosecution?(Required) Yes No If you have answered yes to any question above please provide further details below:(Required)A criminal conviction may not necessarily exclude you from becoming a volunteer for Home-Start, however, certain offences are so serious that in the light of the nature of our work, you would normally be unable to volunteer. These can include: offences against a person or children; sex offences; benefit fraud; theft when in a position of trust; offences when weapons were used; supplying drugs; offences involving violence; serious motoring offences involving imprisonment; burglary; arson with intent to endanger life. If a criminal conviction is declared above, the Trustees will assess the details (which are anonymised) to determine whether or not your application can proceed. They shall assess the risk to children, vulnerable adults, families and Home-Start and consider if steps can be taken to minimise the risk. It is acknowledged that if a risk cannot be sensibly and effectively managed, the ex-offender cannot be involved with Home-Start. Failure to reveal information that is directly relevant to the position will lead to you being deemed as unsuitable to volunteer. Guaranteed Interview SchemeAs part of our commitment to inclusion, we offer guaranteed interviews for specific groups of people. To qualify, you’ll need to meet the minimum requirements for the role, and identify with one of the below criteria:I’m a member of the Armed Forces or veteran(Required) Yes No I am currently in care, or have previously been in care(Required) Yes No I consider myself to be disabled or have a long-term health condition(Required) Yes No Demographics Monitoring Form – This section is optionalFor either employment or voluntary positions, completing this form helps us to identify any existing inequalities and where new inequalities may be developing and take action to tackle them. While it is voluntary to tell us about this information, doing so will help us to better understand and address any disparities or differences in experience or outcomes. Your answers will be treated in confidence, and all data disclosed will comply with the General Data Protection Regulations and any related data protection requirements. In completing this, you are giving us permission to collect and store the data anonymously to help us with our improvement plans. That means we will not hold this data on your records but use it to help us find out more about the wider make up of our communities or the people who work for us. Age: Are you: Under 25 25 – 34 35 – 44 45 – 54 55 – 64 65+ Do you have caring responsibilities? No Primary carer of a child/children (under 18) Primary carer of disabled child/children Primary carer of disabled adult (18 and over) Primary carer of older person Secondary carer (another person carries out the main caring role) Prefer not to say Disability: Do you have an impairment, health condition or learning difference that has a substantial or long term (over a year) impact on your ability to carry out day to day activities? (Tick all that apply) No known impairment, health condition or learning difference A long-standing illness or health condition such as cancer, HIV, diabetes, chronic heart disease, asthma, or epilepsy A mental health impairment, such as depression, schizophrenia or anxiety disorder A physical impairment or mobility issues, such as difficulty using your arms or using a wheelchair or crutches A learning difficulty Blind or have a visual impairment (uncorrected by glasses or lens) D/deaf or hearing impaired Neuro-diverse e.g. dyslexic, dyspraxia or AD(H)D An impairment, health condition or learning difference that is not listed above (please say): Prefer not to say OtherAre you a British Sign Language user? Yes No Prefer not to say What is your ethnic group? (Choose one option that best describes your ethnic group or background) Indian Pakistani Bangladeshi Chinese Any other Asian background, please describe African Caribbean Any other Black / African / Caribbean background, please describe White and Black Caribbean White and Black African White and Asian Any other Mixed / Multiple ethnic background, please describe Arab Any other ethnic group, please describe English / Welsh / Scottish / Northern Irish / British Irish Gypsy or Irish Traveller Roma Any other White background, please describe Please describe What is your main spoken language? English Urdu Arabic Cantonese Polish Bengali Other ( please say) I do not have a spoken language Other language Religion or belief No religion Christian ( including Church of England, Catholic, Protestant and all other Christian denominations) Buddhist Hindu Jewish Muslim Sikh Any other religion, please describe Prefer not to say Other Religion Sex Male Female Intersex Non-binary Prefer not to say Prefer to self-describe( please say): Self-describe sex Is the gender you identify with the same as your sex registered at birth? Yes No Prefer not to say Sexual orientation. Which of the following options best describes how you think of yourself? Heterosexual or Straight Gay or Lesbian Bisexual Other (please say) Do not know or not sure Undecided Prefer not to say Prefer to self-describe (please say) Other orientation Self-prescribe orientation I give permission for Home-Start to check the progression of my DBS application using the online tracker. Once it has been issued to me I give Home-Start permission to register the DBS online on my behalf and use the online system to re-check the DBS every 3 years for the duration of my volunteering activity. I understand that when I leave Home-Start my online DBS record will not be accessed by Home-Start. I understand that Home-Start holds my personal information in relation to this application in both hard and electronic copy and that this may be used for monitoring purposes. I agree to this information being held and understand it may be shared with Home-Start UK for Quality Assurance purposes. I know of no reason why I would be unsuitable to be a Home-Start volunteer and will report anything which I feel may affect my work as a volunteer to a representative of the scheme. I understand that I may ask to see my records at any time or withdraw this permission by putting my request in writing to the Scheme Manager.Consent(Required) I confirm I have read the statement above
