Groundwork

Volunteer Application Form

PERSONAL DETAILS
Name: Date of Birth:

Address: Home Tel No:

Mobile Tel No:

Email

Preferred type of contact:

Volunteer role applied for: How did you find out about Groundwork NE and Cumbria
and this volunteer opportunity?

Which Groundwork member of staff requested you

to complete this form?

ABOUT YOU
Could you tell us why you would like to volunteer with Groundwork?

Could you tell us what skills and experience you can bring to the role?

Please tell us about anything that you feel is important to help us support you to volunteer with us

What hobbies/interests do you take part in your spare time?

Please complete this Application Form in black ink or type

Please state what commitment to voluntary work you can make. e.g. days and times available?
 Mon Tues Wed Thurs Fri Sat Sun
Morning
Afternoon
Evening

Do you possess a current full driving licence? Yes / No

(If relevant to the placement)

Support and Health Needs

Do you have any disability, health needs or extra support needs that we should be aware of when organising
your volunteering, please include allergies or special requirements.

Yes No

If so please give us details to support us in our ability to plan your volunteering:

REFEREES
Please give details of two people that we could approach for references. These people should have known you
for at least 2 years and should not be related to you. Wherever possible these should be employers/past
employers, places you have volunteered, teacher/tutor/social worker. Please ensure that you have obtained
their permission prior to submission. By completing this section we will assume you have given the referee’s
permission to disclose information about you to us
Referee 1 Referee 2
Name

Address:

Tel no:

Email:

Capacity in which you are

known to the referee:

How long have they

known you?
Volunteer Partnership Agreement: Your Partnership with Groundwork NE & Cumbria
Once you have read the following please tick to confirm your agreement below, before submitting the form.

Our commitment to you

What you can expect from Groundwork:
 a clear induction to Groundwork and your volunteer role
 appropriate guidance, training and resources to carry out your activities effectively and to keep yourself
and others safe
 support from regional and national Groundwork staff
 the opportunity to connect with other local volunteers
 regular communication to keep you informed
 to be reimbursed for agreed expenses
 public liability insurance to cover your agreed Groundwork volunteer activities
 to be treated fairly and with respect
 confidentiality of volunteer records as agreed on application
 to follow our problem solving procedure appropriately, should any problems arise.

Your commitment to us
Groundwork expects you to:
 support and promote Groundwork’s aims and values appropriately
 reliably, responsibly and safely carry out your agreed volunteer role
 read and follow Groundwork’s guidance, policies and procedures
 attend relevant training and meetings
 reply to communications from Groundwork’s staff and other volunteers
 volunteer as part of a team, with other Groundwork’s volunteers, staff and partners
 have a friendly, flexible and supportive attitude
 ensure your volunteer activities are recorded on our volunteer website
 treat anyone you encounter when volunteering with fairness and respect
 ensure all volunteer related information and contact details remain confidential, and are only shared
externally with prior agreement.

There may be a time when you wish to end your volunteer role, for example if you have a change in personal
circumstances. If this is the case please let your staff supervisor know as soon as possible.

Groundwork may end your volunteer role if you do not adhere to the volunteer partnership agreement.

If you have any questions about the volunteer partnership agreement, please speak to your staff supervisor.

Please Tick I have read and agree to Your Partnership with Groundwork NE & Cumbria
DECLARATION
Important: The Data Protection Act 1998 requires us to advise you that we will be processing your personal data.
Processing includes: holding, obtaining, recording, using, sharing and deleting information. The Data Protection
Act 1998 defines ‘sensitive personal data’ as racial or ethnic origin, political opinions, religious or other beliefs,
trade union membership, physical or mental health, sexual life, criminal offences, criminal convictions, criminal
proceedings, disposal or sentence and any barring decisions made against the Children’s or Adults Lists under
the terms of the Safeguarding Vulnerable Adults Act (2006), (as amended by the Protection of Freedoms Act
2012).

The information that you provide in this declaration form will be processed in accordance with the Data
Protection Act 1998 and the General Data Protection Regulations. It will be used for the purpose of determining
your application for this position.

Once a decision has been made concerning your appointment, Groundwork NE & Cumbria will not retain this
information for any longer than necessary. Your personal information will be kept securely and in confidence.
Access to this information will be restricted to designated persons within the trust who are authorised to view it
as a necessary part of their work.

We will only use your personal information when the law allows us to. Most commonly, we will use your personal
information in the following circumstances:

1. Where we need to perform the contract we have entered into with you.
2. Where we need to comply with a legal obligation.
3. Where it is necessary for our legitimate interests (or those of a third party) and your interests and
fundamental rights do not override those interests

A Privacy Notice providing further Information on how we process your personal data is available on our website
at www.groundwork.org.uk/sites/northeast or by contacting the HR Department.

In signing the declaration on this form, you are explicitly consenting for the data you provide to be
processed in the manner described above.

I consent to the information provided in this declaration form being used by Groundwork NE & Cumbria for the
purpose of assessing my application, and for enquiries in relation to the prevention and detection of fraud.

I confirm that the information that I have provided in this declaration form is correct and complete. I understand
and accept that if I knowingly withhold information, or provide false or misleading information, this may result in
my application being rejected, or if I am appointed, in my dismissal, and I may be liable to prosecution.

Signed: ………….................................... ………..

Date: ……………………………………….

Name: ..............................................………............
(Block Capitals)

Please ensure that you have read and checked this Application Form thoroughly prior to submission
ensuring that you have completed all of the relevant information carefully.
Please complete this form and return it to the HR Department with your application pack. The
information on this form will be used for monitoring purposes only and will not be used in any
decision affecting you.

Groundwork North East is committed to ensuring that all job applicants and members of staff are treated
equally, without discrimination because of gender, sexual orientation, marital or civil partner status, gender
reassignment, race, colour, nationality, ethnic or national origin, religion or belief, disability or age. This form is
intended to help us maintain equal opportunities best practice and identify barriers to workforce equality and
diversity.

Please tick one box in each section Completing the last two sections is optional
Gender
Female  Male  Transgender  Prefer not to say 

Age group
Under 25  25-34  35-44  45-54  55-60  Over 60  Prefer not to say 

Ethnicity

Please tick the box which best describes your ethnic background?
White Mixed/ Asian/Asian Black/Black Chinese Other Ethnic
British British Group
 British  White & Black Caribbean  Caribbean  Chinese  Traveller/Gypsy
If you wish to  White & Black African  African
specify:  White & Asian Other Black
 English  Other Mixed background background  Other
 Scottish  Indian background
 Welsh  Pakistani Please state:
 Northern Irish  Bangladeshi
Other Asian background
 Irish

 Other White
Background

 I prefer not to say

Disability
The Equality Act 2010 defines a disability as a “physical or mental impairment which has a substantial and
long-term adverse effect on a person’s ability to carry out normal day-to-day activities”. An effect is long-term
if it lasted, or is likely to last, more than 12 months.

Do you consider that you have a disability under the Equality Act 2010?

Yes  No  Don’t know  Prefer not to say 

If you do not consider that you meet this definition but consider that you have a disability please advise us.

_____________________________________________________________________________________

Please let us know what your disability is and how we can support you if you require assistance or
adjustments to be made to enable you to attend and participate in the interview if selected.
_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Please let us know how we can support you if you will require adjustments to be made to enable you to:

 Undertake the role

 Participate in any training programmes

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

Religion or Belief (optional question)

None  Christian  Buddhist  Hindu  Jewish  Muslim  Sikh 

Prefer not to say  Any other religion or belief _______________________________ (please provide details)

Sexual Orientation (optional question)

Bisexual  Heterosexual  Homosexual  Other  Prefer not to say 

Many thanks for completing this questionnaire – please be assured all information will be kept in the
strictest of confidence
 CRIMINAL CONVICTION DECLARATION FORM

Please complete this declaration and return it marked confidentially with your application pack to the
HR Department:

If your application is successful and you take up engagement as a volunteer with us, it is possible
that you will be asked to verify the information given here by obtaining a Disclosure through the
Disclosure and Barring Service. This information will be made clear on the job advertisement
and the Job Description.

This form will stored confidentially and only be considered if you are shortlisted for interview. If you
are not shortlisted, the envelope and its contents will be destroyed unopened at the end of the
recruitment process.

This post is covered by the provisions of the Rehabilitation of Offenders act 1974 and as
such only UNSPENT convictions need to be declared.

or

This post is not covered by the provisions of the Rehabilitation of Offenders act 1974 and as
such all SPENT and UNSPENT convictions need to be declared.

Name:____________________________________________________________

Do you have any unspent / spent criminal (delete as appropriate) convictions?

YES NO

If you answered ‘YES’ please give details:

Offence Details Sentence Date of Sentence

The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and
cautions are ‘protected’ and are not subject to disclosure to employers, and cannot be taken into
account. Guidance and criteria on the filtering of these cautions and convictions can be found at the
Disclosure and Barring Service website.

This information given by me on this form is, to the best of my knowledge and belief, true and
correct. I also understand that any misrepresentation by me will lead to the withdrawal of any offer
of volunteering role or my volunteering role being terminated without any obligation of liability on the
part of Groundwork other than for services rendered.

Signed____________________________________Dated____________________________
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