Title TitleMrMrsMsMissDrOther

Name

Address

Postcode

If you have lived at this address for less than 5 years, please give previous address details.

Email Address

Telephone Number

Date of Birth

Place of Birth

National Insurance Number

Have you ever been known by any other name? Have you ever been known by any other name?YesNo

If yes, please give details.

Nationality at Birth

Emergency Contact Name

Emergency Contact Number

Have you volunteered before? If yes please give details.

Do you hold a current driving licence? Do you hold a current driving licence?YesNo

Are you willing to drive as a volunteer? Are you willing to drive as a volunteer?YesNoN/a

Do you speak any additional languages (including sign language)?

How much time would you expect to be able to commit to Dad Matters as a volunteer?

Have you got any commitments which could affect your volunteering availability e.g. work, regular hobbies?

How did you hear about Dad Matters?

Why would you like to become a Dad Matters volunteer?

Referee 1

How long have you known the referee?

In what capacity?

Address

Postcode

Email

Telephone Number

Notes

Referee 2

How long have you known the referee?

In what capacity?

Address

Postcode

Email

Telephone Number

Notes

Please read the following carefully and confirm before signing and submitting your application. Please read the following carefully and confirm before signing and submitting your application. You understand the post you are applying for is 'exempt' from the Rehabilitation of Offenders Act 1974 and therefore, you are required to declare any convictions, cautions, reprimands and final warnings that are not 'protected' (i.e. filtered out) as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order (as amended). The amendments to the Exceptions Order provide that certain 'spent' convictions can be found on the Disclosure and Barring Service website. Further information can also be found on the Nacro webite. Disclosure of criminal records will be requested from Carecheck DBS Service to assist with decision making for this role. Please note: A criminal record will not necessarily be a bar to an applicant obtaining a volunteer position. A copy of the following policies are available on request: the Home-Start St Helens - Ex-Offenders Policy, the Code of Practice and the Home-Start St Helens Policy on Handling Disclosure information.

Do you have any convictions, cautions, reprimands or warnings that are not "protected" as defined by the Rehabilitation of Offenders Act 1974 (Exception) Order (as amended). Do you have any convictions, cautions, reprimands or warnings that are not "protected" as defined by the Rehabilitation of Offenders Act 1974 (Exception) Order (as amended).YesNo

Are you, or have you ever been the subject of fitness to practice proceeding by a UK or overseas licensing regulatory body? Are you, or have you ever been the subject of fitness to practice proceeding by a UK or overseas licensing regulatory body?YesNo

If you have answered yes to any of the above, please give full details.

Confidentiality Confidentiality During the course of their work, volunteers will be aware of information concerning the Charity's activities, its staff and other personal information relating to children and their families. I understand that this is confidential information and must not be used for any purpose other than the performance of duties. It must not be divulged to unauthorised persons, nor used for the production of articles, books etc. without the Charity's specific agreement.

Your Data Your Data All of the information collected in this form is necessary and relevant to the performance of the volunteer role applied for. We will use the information provided by you on this form, by the referees you have noted and any criminal record checks for recruitment purposes only. Home-Start St Helens will treat all personal information with the utmost confidentiality and in line with current protection legislation. Should you be successful in your application, the information provided, and further information which will be gathered at the relevant time, will be subsequently used for the administration of your volunteering with us.

Confirmation Confirmation I confirm that the information on this form is correct and that I have not knowingly withheld any material facts. Under the Data Protection Act 2018, I hereby consent for the information in this application form, about myself and others, to be processed by Home-Start St Helens for the purposes of recruitment. I hereby give me permission to those individuals or organisations contacted for the purpose of this background check to give their full and honest evaluation of my suitability for the described volunteer role and other information as they deem appropriate.