Volunteer Details & Preferences
East Durham Trust
Moving our community forward
Section 1
Mr
Mrs
Miss
Ms
(please circle one)
First name…………………………………………………………………………….
Surname………………………………………………………………………………
Address………………………………………………………………………………
…………………………………………………………………………………………
County………………………………………….Postcode………………………..
Geographical area (Office use only)……………………………………………….
Daytime telephone number……………………………………………………….
Evening telephone number………………………………………………………
Mobile………………………………….Fax…………………………………….
E mail………………………………………………………………………………….
How did you hear about East Durham Volunteer Centre?
………………………………………………………………………………………….
Section 2
Please take a few minuets to look through the following lists. The Areas
of Interest and the Activities that you choose help us match you with
volunteering opportunities.
Areas of Interest
Please tick any of the following that
interest you:
Animals
Art & Culture
Children
Disability
Disaster Relief
Domestic Violence
Drugs & Addictions
Education & Literacy
Emergency Services
Elderly
Employment
Environment
Families
Gay/Lesbian /Bi &
Transsexual
Health / Hospital / Hospices
Heritage
Homeless & Housing
Human & Civil Rights
International Aid
Legal Aid & Justice
Mental Health
Mentoring
Millennium Volunteers
Museums
Music
Politics
Prisoners & Ex offenders
Race Ethnicity & Refugees
Religion
Sport & Outdoor Activities
Women’s Groups
Youth
Type of Activity
Please tick any of the following that
you would like to do:
Administration
Advice Work
Architecture & Building work
Art
Befriending / Buddying
Business & Management
Campaigning & Lobbying
Caring
Catering
Community work
Computers, Technology &
Website Design
Counselling
Driving
Employee/ Group
Volunteering
Entertainment
Finance Work
First Aid
Fundraising
Gardening
General & Helping
Hostel Work
Languages
Legal Work
Local Events
Marketing / PR / Media
Mentoring
Music
National / International
Events
Officials
Practical and Do It Yourself
Retail & Charity Shops
Teaching / Training/
Coaching
Trusteeship and Committee
Under 16s Volunteering
Youth work
Section 3
Please give brief details of any voluntary work or previous work
experience.
Organisation …………………………………………………………………………
Location ………………………………………………………………………………
Period of involvement ……………………………………………………………..
Description of duties ……………………………………………………………….
…………………………………………………………………………………………..
…………………………………………………………………………………………..
…………………………………………………………………………………………..
(If completed please complete section 6)
Office use only
Available
Not available
Placed
Registered an interest
Special skills
Please tick each box when you could be available as a volunteer or tick
“ALL” if availability is flexible
ALL
AM
PM
EVE
Mon
Tue
Wed
Thu
Fri
Sat
Sun
Section 4
Date of birth:
Gender:
Male
Female
Which age group are you in?
(circle one)
(tick one)
Under 15
15-18
19-25
26-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
Over 65
What is your current employment status?
(tick one)
Employed
Non employed
House person
Retired
Student
Unable to work
Unemployed
Which ethnic group do you feel you belong in?
White British
White British (English)
White British (Scottish)
White British (Welsh)
White Irish
Other White background
White & Black Caribbean
White & Black African
White & Asian
Other Mixed background
(tick one)
Indian
Pakistani
Bangladeshi
Other Asian background
Black Caribbean
Black African
Other Black background
Chinese
Any other background
Nationality……………………………………………………………………………
Are you disabled?
No
Yes
Self Classified
Section 5
Driving. Only complete these questions if you drive. (tick one)
Insured for voluntary driving
Own transport available
If you can drive what license type do you hold? (tick one)
Car automatic
Car Full
Car Provisional
HGV – Class 1
HGV – Class 2
HGV – Class 3
Motorcycle
PSV / Coach
Section 6
Do you consent to receiving information periodically from East Durham
Trust?
Yes □
No □
Signed ……………………………… Date …………………