Volunteer application form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Full Name * can with relation Date of Birth *Address: *Telephone (Home):Telephone (Mobile): *Email *Are there any special arrangements we need to make for interview?Your skills and experience *How can we support you?Have you received formal mediation or conflict resolution training previously? Getting around Do you have your own car and valid driving licence? *YesNoIf yes, are you willing to use the car for volunteering? *YesNo Availability Please tick your availability in the boxes below: *Monday - MorningMonday - AfternoonMonday - Evening(Repeat for all days and times)Please write any comments on availability below Current employment status Are you currently *EmployedSelf-employedUnemployedFull time educationRetired Please give the names and contact information of two people who can give you references, where in employment one must be your current employer. Referees can be previous employer, volunteer manager or any other responsible person. Your references will be contacted before the interview process. Referee Name *Referee Name *Address *Address *Contact Number *Contact Number *Email *Email *Relationship to you *Relationship to you *How long have they known you? *How long have they known you? * Volunteer Conviction Declaration Your role may place you in contact with vulnerable people. Current legislation allows us to ask some questions regarding any convictions, either spent or unspent, no matter how long ago they were. Having a criminal conviction does not automatically prevent you from volunteering. We will consider information sensitively in line with legislation and the purpose of the role. The information you provide will be strictly confidential and will be considered only in relation to the position you are applying for.I confirm that I have NO spent or unspent convictions/cautions/reprimands, either in the UK or elsewhereI have spent and/or unspent convictions/cautions/reprimands, details of which are noted belowOffence Date of conviction/caution/reprimandPenalty Our full privacy notice outlines your rights and our obligations to handle your data correctly, please contact us to see a copy. *I can confirm that the above information, to the best of my knowledge, is accurate. I understand that failure to provide information that may influence the engagement decision will be viewed as a serious matter. I understand that if I become a volunteer with ADR Mediation & Training CIC, I must advise them of any convictions recorded against me in the future.Signed: *Date: *Name: * Monitoring Form (Optional) Gender MaleFemaleTransgenderPrefer not to answerAge Under 1616–2425–3435–4950–6465+Prefer not to answerEthnicity Asian – Bangladeshi, Chinese, Indian, Pakistani, OtherBlack – African, Caribbean, OtherWhite – British, Irish, OtherMixed Heritage, Traveller (Romany, Irish Traveller), OtherPrefer not to answer Disability Do you consider yourself to have a disability?YesNoPrefer not to answerto answer If yes, please describe your impairmentSexual OrientationBisexualHomosexualHeterosexualPrefer not to answerReligion BuddhismCatholicismHinduismJudaismIslamProtestantismNo religionPrefer not to answerSubmit Application
