Ad-Hoc Volunteer Form
To apply for Ad-Hoc volunteer opportunities with Day One, please complete the following form. You can
use this form to apply for a specific Ad-hoc volunteer role we may have advertised or to be added to our
Ad-Hoc volunteer database and be contacted for future events.
Personal Details
Title: Miss / Mrs / Ms / Mr / Other:
Date Of Birth: (18+ only)
First name:
Surname:
Address:
Postcode:
Telephone:
Mobile:
Email:
Ad-Hoc Role
Advertised Position:
I am interested in helping at these types of events (please tick):
General Ad-Hoc roles as required
Cake Bakes/raffles/stalls
Presentation evenings
Sporting events
Information stands
Other
Availability
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
AM
PM
Evening
About You
Please tell us a little bit about yourself: Why you want to volunteer, any past volunteer experience you might have,
your skills and hobbies and other information you’d like to tell us.
Monitoring Information
Leeds Teaching Hospitals Charitable Foundation recognise and actively promote the benefits of a diverse workforce and are
committed to treating all volunteers with dignity and respect regardless of; age, disability, gender reassignment, marriage and
civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation. We therefore welcome applications from all sections of the community. Information collected is anonymous and helps support equal opportunities policies at
LTHCF.
Which best describes your sexual orientation:
Gender:
Male
I do not wish to disclose
Heterosexual
Bisexual
Female
Lesbian
Gay
I do not wish to disclose
I would describe my Ethnic Origin as:
Asian or Asian British
Bangladeshi
Indian
Pakistani
Any other Asian Background
Mixed
White and Asian
White and Black African
White and Black Caribbean
Any other Mixed Background
Black or Black British
Africa
Caribbean
Any other Black Background
White
British
Irish
Any other White Background
Other Ethnic Group
Chinese
Any other Ethnic Group
I do not wish to disclose
Please indicate your religion or belief:
Atheism
Janism
Other
Buddhism
Sikhism
I do not wish to disclose
Christianity
Judaism
Islam
Hinduism
Do you consider yourself to have a disability? (Please note: it might impact your ability to volunteer if you do not
disclose any relevant disabilities of medical conditions).
Yes
No
If yes which impairment applies to you:
Physical
Sensory
Long Standing Illness
Learning
I do not wish to disclose
Mental Health Problem
Other
Emergency Contact
Name:
Relationship:
Telephone:
Email:
Declaration
I understand that I must be 18+ years to volunteer with the Charity and that a successful application for an Ad-Hoc volunteer
position allows me to volunteer on an non-regular basis with the charity, only at their request and that I must only carry out
tasks as assigned by a staff member. To become a full time volunteer with the charity and the NHS trust I understand that I
must complete the official Leeds Teaching Hospitals NHS Trust Volunteer Application process in full; including a DBS clearance
check and references, as such I recognise that I am not authorised to volunteer on wards and departments and should not
carry out tasks where I am unsupervised with children or vulnerable adults. Leeds Teaching Hospitals Charitable Foundation
retain the rights to dismiss any volunteer who fails to abide by the organisations policies and procedures.
Print:
Sign:
Date:
Thank you for your interest in becoming an Ad-Hoc Volunteer.
Please complete and return this form to:
Leeds Teaching Hospitals Charitable Foundation, Ground Floor, Trust HQ, St James’s Hospital, Beckett Street, Leeds LS9 7TF.
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