VOLUNTEER APPLICATION
Please use dark ink or type
Post applying for:
Volunteering opportunity:
I heard about ESCAPE through
Newspaper Advert (please state which newspaper etc.)
Website (which one)
Job Centre (which one)
Shop window (which one)
Other source (which one)
Personal details (please print clearly)
Title:
Surname:
Forenames
Telephone (home)
Address
Telephone (mobile)
Email Address
Postcode
All appointments are subject to a CRB disclosure and checks
will be made before a candidate is offered a post.
(Please refer to guidance notes before completing the application form)
CONFIDENTIAL
Equal Opportunities/ Disability Monitoring
This information will be treated in the strictest confidence and removed from applications
POST APPLIED FOR:
ESCAPE has a commitment to interviewing all applicants who have a disability and who meet the minimum criteria for the person specification for the
post.
Do you consider yourself to have an impairment? YES
No
If you consider yourself to be disabled and you are selected for interview,
please indicate on the reverse of this sheet the types of aids, adaptations,
equipment or special arrangements you need to assist you at interview (eg
interpreter for the deaf).
I would describe my ethnic group as (please circle)
A. White
Scottish English; Welsh Irish; Any other white background,
please specify:
B. Asian, Asian Scottish, Asian English, Asian Welsh or Asian
British
Indian; Pakistani; Bangladeshi; Chinese; Any other Asian background,
please specify:
C. Black, Black Scottish, Black English, Black Welsh, or other Black British
Caribbean African; Any other Black background,
please specify:
D. Mixed
Any other Mixed background,
please specify:
E. Other ethnic background
Any other background,
please specify:
Thank you for your assistance
EDUCATION and TRAINING
You will be required to produce original certificates of qualifications and
professional registration of all qualifications you give below at interview, please
continue on a separate sheet if necessary.
EDUCATIONAL ESTABLISHMENTS i.e School, college, higher education :
Establishment (school, college etc, workplace)
Date from
SUBJECT
Date Attained:
eg GCSE/ ‘A’ Level / Degree/
NVQ / Workshop / OCN
Date To
Present/Most Recent Employment/VOLUNTEERING
Name & Address of Employer/Organisation:
Job or Volunteering title:
Date of appointment
Date left (if applicable)
Salary & other benefits
Reason for leaving (if applicable)
Main duties & responsibilities. Continue on a separate sheet if necessary.
Previous Employment/Volunteering
Please give details of all posts you have held, with the most recent first. Please
include any gaps in employment with explanation. Continue on a separate
sheet if necessary.
Dates employed
(from to)
Employer’s/
Job title and brief description of main
Organisation name duties
and address
Reason for
leaving
Supporting Statement/Additional Information
Please refer to the volunteer role description when completing this
section.
Continue on a separate sheet if necessary. Please limit to no more than
two sides of A4.
Additional Information
Driving
Do you hold a current full driving licence?
YES
NO
Do you have any current driving
convictions?
If yes please state convictions
YES
NO
YES
NO
Are you related to/or do you have a
personal relationship with any employee
of ESCAPE?
If Yes please specify:
REFERENCES
References
Please give the names and addresses of two referees it is helpful if references can be
given from voluntary work/school groups or committees.
Referee
Referee
Name
Referee’s job title
Address
Name
Referee’s job title
Address
Postcode
Telephone
Contact before interview? Yes
Postcode
Telephone
Contact before interview? Yes
No
No
Criminal convictions
Do you have any criminal convictions?
Please circle your response
If Yes please give details on a separate sheet,
YES
NO
place in an envelope and mark FAO Janet Murphy, this should exclude any spent convictions under Section 4(2) of the Rehabilitation of Offenders Act 1974, unless the job for which you are applying
involves working with vulnerable adults or children in which case cautions, bindovers,
pending prosecutions, spent and unspent convictions must be declared.
Declaration
In accordance with the Data Protection Act 1998, the information provided
on this form will be used in the recruitment and selection process and may
be disclosed to all those who need to see it. It will also form the basis of the
confidential personnel record of the successful candidate. In the case of
unsuccessful candidates the Application Form will be destroyed after six
months.
I hereby declare that to the best of my knowledge, all the information given
by me is correct, and that I possess all the qualifications I have listed on this
form. I confirm that I do not object to the information collected on this form
being transferred onto computer for the purpose of anonymous statistical
reporting, in accordance with statutory requirements, and to assist ESCAPE
in equal opportunities monitoring in respect of job applications. I agree that
ESCAPE has the right to validate any of the information provided.
I understand that any false statements could result in my dismissal if
appointed. I Confirm that I am legally eligible to work in the United
Kingdom.
Signature
Please return this form to:
HR Department,
Emily Davison House,
93 Bondicar Terrace,
Blyth,
Northumberland,
NE24 2JR.
Date_____________________