Database:
References:
(For Office use only)
Volunteer Application Form
Please fill out this form in BLOCK CAPITALS.
All information will be treated as confidential, please complete clearly and circle Y for yes & N for no
Please state which programme you are applying for________________________________________
(For information on our different programmes please visit our website www.solasproject.ie)
Name: _________________________________ Date: _____________________________________
Date of Birth: ______________________________ Nationality: ______________________________
Any previous surname: ___________________
Mobile No. ________________________________
Phone number: _________________________
Email Address:______________________________
Address: __________________________________________________________________________
__________________________________________________________________________________
If less than 2 years, please give previous address: _________________________________________
_________________________________________________________________________________
Occupation:_______________________________________________________________________
Please give details of previous experience of work with children/young people, including training
completed e.g. First Aid, outdoor pursuits, child protection training etc.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Please give details of relevant skills
__________________________________________________________________________________
__________________________________________________________________________________
Describe your reasons for wanting to volunteer ___________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Are your prepared to attend team meetings and undertake appropriate training?
Y
Are you involved in any other voluntary work?
Y
N
N
If yes, please give details _____________________________________________________________
Have you had treatment for any illness during the past 5 years which may have a bearing on your
ability to work with children / young people?
Y
N
If yes please give details: _____________________________________________________________
__________________________________________________________________________________
Has your conduct ever caused or been likely to cause significant harm to a child/young person, or put
a child/young person at risk of significant harm?
Y
N
To your knowledge, has a complaint ever been made against you or are there any pending
complaints against you in a working environment or in a voluntary capacity?
Y N
If yes please give details
______________________________________________________________________
__________________________________________________________________________________
To your knowledge, has it ever been alleged that your conduct has resulted in any of the matters
raised in the previous question? This question relates to any conduct, whether in a paid capacity, as
a voluntary worker or otherwise.
Y
N
If yes please give details
______________________________________________________________________
__________________________________________________________________________________
Are your currently or have you ever been investigated, charged or convicted of a criminal offence?
Y N
If yes please state the nature and date(s) of the offence(s) _________________________________
__________________________________________________________________________________
Have you even been held liable by a court for a civil wrong e.g. order made against you by a
matrimonial or family court?
Y
N
If yes please give details _____________________________________________________________
__________________________________________________________________________________
Are you willing to go through a Garda Vetting Procedure (which is now a standard requirement for
anyone working with children / young people)?
Y
N
Please give the name, address, email address and daytime contact numbers of two people (not family
members or partner/boyfriend/girlfriends) who know you well e.g. teacher, colleague, employer and
who would be willing to give you a reference. Please ensure that you have obtained the consent of
the person before you offer them as a referee.
It would be helpful if, at least, one of your referees knows you in the context of children / young
people.
First Referee
Second Referee
Name: _______________________________
Name: ______________________________
Relationship to you: ____________________
Relationship to you: ___________________
Address: _____________________________
Address: ____________________________
_____________________________________
_____________________________
Contact No. ___________________________
Contact No. _________________________
Email ________________________________
Email_______________________________
Please indicate referees’ preference for supplying your reference by e-mail or letter – tick one box for
each referee
E-mail
Phone
E-mail
Phone
Please return this form to us by post or email to:
Solas Project, 40 Marrowbone Lane, Dublin 8 or [email protected]
For office use only
Date rec’d _________________
Signed: ________________________________
Notes:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________