Have you spoken with us?

We like potential Volunteers to have a chat with the person who runs the service they wish to volunteer with, to make sure they are happy with what their chosen role entails, before they complete the application form.

If you haven't already had a chat please email volunteers@ageuksomerset.org.uk or call 01823 345627 before proceeding with this form.

If you have spoken with someone please fill in the details here.

I've had a chat about the role with...

Personal Information

Title

If you selected 'Other' please state.

First Name(s)

Surname

What do you prefer to be known as?

Date of Birth (please enter as DD/MM/YYYY)

First line of Address

Address line 2

Town (or Village)

Postcode

Which District/Area do you live in?

Telephone Number (Home)

Telephone Number (Mobile)

email address

We are exploring other ways of contacting Volunteers when we need to do so quickly. Which of the following do you use? WhatsApp Text Messaging Facebook Facebook Messenger None of the above

Your Volunteer role

Which Volunteer role are you applying for? If you need a reminder of our roles please visit: https://www.ageuk.org.uk/somerset/get-involved/volunteer/ 'Walk and Talk' Wellbeing Friends Ageing Well - Sit, Fit and Fun Ageing Well - Other Friendly Phone Calls Information & Advice Support Memory Connections (MCST) Other

If you ticked Other please state role.

Why do you wish to Volunteer with Age UK Somerset and what do you wish to gain from the experience?

Please tell us about any experience you have had with Volunteering, or working with older people, or any skills, interests or hobbies that may be relevant.

If you selected Other, please explain.

Other information

Transport

How do you get around? Own car Bicycle On foot Public transport Other

If you selected 'Other' please give details

Age UK Somerset is committed to equal opportunities. So that we can consider any appropriate adjustments to the volunteer environment, and better support you in your role, please give details below of any disabilities, health issues (e.g. a bad back) or support needs you have.

References

Referee 1

Name

Telephone number

email address (our preferred method of contact)

In what capacity does this person know you?

Referee 2

Name

Telephone Number

email address

In what capacity does this person know you?

DBS checks

Many of our Volunteer roles will require a Disclosure and Barring Service (DBS) criminal record check for our clients and their family’s safety and peace of mind.

If you have had a criminal conviction this would not automatically disqualify you from volunteering with us - each case is reviewed by the Chief Executive and depends on the nature of the position and the circumstances and background of the offences. However any prospective Volunteer who has a conviction relating to vulnerable adults will not be accepted. More details are in our policy on the Recruitment of Ex-offenders - available on request.

Do you consent to a DBS Disclosure being undertaken if necessary for the role? Yes No

Do you have any convictions, cautions, reprimand or final warnings that are not “protected”* as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013)? Yes No

If you answered 'Yes' please give details.

In case of Emergencies

Emergency Contact Name

Emergency Contact Telephone Number

What is their relationship to you?

Declaration

How we use your information

In furthering your enquiry and your application to volunteer with us, we may use your personal data, any sensitive health data you share and criminal record data to attend to our legal obligations, your vital interests and our mutual legitimate interests. We are then able to safely and efficiently administer our volunteering services.

We will process your data in a way that you would expect us to, which may include contacting you about your initial application, making assessment decisions about your suitability for our volunteering roles, contacting you regarding any subsequent volunteering activity that you may participate in thereafter, sending you information relating to our activities and volunteering, monitoring the quality of our service, arranging out-of-pocket payment expenses to you and exercising our duty of care towards your safety and wellbeing.

For more details on how your data is used and stored, please read our Privacy Notice for Volunteers here, or to ask us any questions about this please telephone us on 01823 345610.

(Ref: Vol Application Notice 10/18)

Do you share Age UK Somerset's Vision, Mission and Values?

The VISION of Age UK Somerset is:

‘That older people, their families and carers, have opportunities and access to information and services that enable them to make choices so that they experience fulfilment and satisfaction in later life.’

To help make that vision a reality, our MISSION requires us:

‘As an organisation, and working with partner organisations, to provide valued services and promote the wellbeing and independence of older people, in all their diversity, helping them live longer and better.’

The values we will seek to promote will include:

Using the independence of our organisation to direct our business and select our objectives so that we maximise the independence of the individual
Striving to earn the respect of our partners and users as well as respecting the wishes and aspirations of others
Seeking to ensure that the lifestyle and circumstances of older people guarantees their dignity at all times
Looking to empower older people
Celebrating diversity and always offering equality of opportunity

In dealing with each other and with all older people, all staff, trustees and volunteers will demonstrate Kindness, Empathy, Compassion, Patience and Care.

Please Note: Age UK Somerset is not able to accept volunteer applications from those who are not willing to commit to Age UK Somerset’s Vision, Mission and Values, or from those that Age UK Somerset considers to be unsuitable for the role.

The agreement between volunteers and Age UK Somerset is voluntary on both sides and either party can bring this to an end.

DECLARATION BY YOU

By adding your full name below you are agreeing with the following statements:

I declare that I have understood this form and that the information I have given on this form is correct.
I understand that you will use the information I have provided in the way outlined above.
I agree to support the Vision, Mission and Values of Age UK Somerset

Full name

Date

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