VSSH - VOLUNTEER REGISTRATION FORM

Confidential

Title First Name Surname

Address
         Line 1
         Line 2
         Town    Post Code

Contact details
Tel No Day      Mobile Evening
         Fax No   E-mail

Where did you hear about VSSH?
Area of interest
 
Type of Activity 
 
Past work or voluntary work
 
Availability 
  Sat. Sun. Mon. Tue. Wed. Thurs. Fri.
a.m.
p.m.
evening
Special Skills If yes please describe
 
Personal details
Date of birth: (dd/mm/yy)
Gender
Employment status
   Employed Houseperson Non-employed Retired
   Student Unable to work unemployed
Ethnicity Nationality Religion
 
Do you have any disabilities that could affect the type of volunteer work you could do?
 
Do you agree to a CRB disclosure if required?
If you wish to be a volunteer driver
 Have you got a car available?
 Are you insured for volunteer driving
 What type of licence do you hold?
May we contact you in the future to check on your progress? 
 
The information on this form will be held on computer for the purposes of our referrals. Please note that you are entitled to copies of any information held about you on our system. It may be necessary to pass this information to statutory/voluntary organisations in order for them to contact you.
Please tick this box if you do not want this done.