Volunteering, Involvement and Work Experience

APPOINTMENT FORM - VOLUNTEERS
Part A - To be completed by Volunteer with full details. Please enter first/surname as
shown on passport/birth certificate
PERSONAL DETAILS
Title: ___________________________Surname: _______________________________
First & __________________________ Preferred Name: _________________________
Middle Name(s):
Maiden Name: ____________________Previous Name: _________________________
Home Address: __________________________________________________________
________________________________ Post Code: _____________________________
Home Telephone No: _____________ Mobile Telephone No: ____________________
Personal e-mail address: __________________________________________________
Date of Birth
National Insurance
Number
Nationality
Ethnic Origin
(Please select from the list below)
Gender
Country of Birth
Marital Status
Religion
Do you consider yourself
to have a disability
Yes/No
Sexual Orientation
(Please select from the list below)
(Please select from the list below)
Single/Married/Civil
Partnership/Separated/Divorced/Widow
CODE
ETHNIC CATEGORIES
A - White – British
B - White – Irish
C - White – Any Other White Background
D - Mixed – White & Black Caribbean
E - Mixed – White & Black African
Religious Belief
Atheism
Buddhism
Christianity
Hinduism
Islam
F - Mixed – White & Asian
G - Mixed – Any Other Mixed Background
H - Asian or Asian British – Indian
J - Asian or Asian British - Pakistani
Jainism
Judaism
Sikhism
Other, please state.
K - Asian or Asian British – Bangladeshi
L - Asian or Asian British – Any Other Asian
Background
M - Black or Black British – Caribbean
N - Black or Black British – African
P - Black or Black British – Any Other Black
Background
R - Chinese
S - Any Other Ethnic Group
I do not wish to disclose my
religion/Belief
Sexual Orientation
Bisexual
Gay
Heterosexual
Lesbian
I do not wish to disclose my sexual
orientation
EMERGENCY CONTACT DETAILS
Emergency Contact
(Title and Full Name)
Emergency Contact
Relationship
Emergency Contact
Address (including
postcode)
Emergency Contact
Home Telephone
Number
Emergency Contact
Mobile Telephone
Number
BANK / BUILDING SOCIETY DETAILS
(Please note: Bank details are only required for those who will receive expenses via their bank
accounts)
Name of Bank/Building Society: ____________________________________________
Branch Address: _________________________________________________________
________________________________________________________________________
Account Name: __________________________________________________________
Account Number: ______________________ Sort Code: ________________________
Roll Number (if applicable): _________________________________________________
Volunteer’s Name (Please print your name clearly): ____________________________
________________________________________________________________________
Volunteer’s Signature: ____________________________________________________
Date: ___________________________________________________________________
Part B - To be completed by Volunteer’s Supervisor
Volunteer Post Details
Nature of Voluntary Work:
Voluntary Post Title:
Department/Team:
Direct Supervisor Name and Telephone Number:
Base:
Start Date:
Cost Code:
Hours:
Expected Term of Voluntary
Post:
Business Division (please circle):
Authorised by (signature):
PLD
CRP
Print Name:
Contact Number:
Address:
WAA
CYP
OPM
Manager / Administrator
for ESR Self Service *
* ESR Manager Self Service is being rolled out Trust wide during 2013/2014. The details provided
here will govern which Manager / Administrator will approve any requests. If your team is not yet
using Manager or Administrator Self Service please leave this field blank.
Part C - To be completed by Involvement and Volunteering
Entered on ESR by:
Assignment Number:
Position Number:
Date:

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