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CONFIDENTIAL
Mr. Mrs. Miss. Ms. (circle one) Gender: Male Female (circle one) .. . .. e-mail: .. Evening: . Mobile: . .. . ..
First name: Surname: Address: Post Code Telephone: Daytime: E-mail: mail:
Please take a few minutes to look through the following lists. The Areas of Interest and the Activities that you choose help us to match you with volunteering opportunities. Areas of Interest - Please tick any (3) of
the following that Interest you: Administration Children and Young People Disability Employee and Group Volunteering Languages Marketing and PR and Media Trusteeship and Committee Work Computers, Technology and Website
Please tick each box when you could be available as a volunteer. Mon AM PM EVE
Full Time or Main Occupation (if applicable): applicable) Date Appointed:
Tues
Wed
Thu
Fri
Sat
Sun
Post Code:
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Please give brief details of any previous voluntary work, paid work experience, qualifications, skills etc. Please include any youth work training or qualification; course details and dates.(Please continue on a separate sheet if necessary)
Yes
No
(Please Circle)
Briefly outline any personal interests skills and/or experience that you feel may be relevant to this post.
Please state why you are interested in becoming a Voluntary Youth Worker.
For this post you will be expected to have an understanding and commitment to equal opportunities and to work in a way that challenges discrimination. Please state your understanding of equal opportunities.
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Yes
No
(If the voluntary work involves helping with children/young people/vulnerable adults, all criminal offences must be declared and are exempt from the provision of the Rehabilitation of Offenders Act 1974) If YES, please give details:
References: Name and address of two responsible people who have known you for over two years and are not members of your family, to whom Crossroads Care - South Thames might apply for a reference.
Name Address Name Address
Data Protection:
These records are confidential to Crossroads Care - South Thames. You are entitled to inspect any record we keep about you. No information will be passed on without your consent to a third party.
Signature:
Date:
Please return your form to: YCP Volunteer Applications, Crossroads Care - South Thames, Woodlawns, 16 Leigham Court Road, Streatham, SW16 2PJ. Please mark the envelope Private and Confidential.
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