Title*
—Please choose an option—MrMrsMissMsDr

Full Name*

Contact Number*

Email*

Volunteering Area*
—Please choose an option—Courses/EventsBirmingham HomelessCoventry HomelessWalsall HomelessSheffield HomelessLiverpool HomelessLeicester HomelessBristol HomelessFoodbankNew RootsYouthDawahFundraisingOther

If other, please specify

Please let us know why you would like to become a volunteer with us?*

What is your current or most recent job role? Please also tell us any work or voluntary experience you have relevant to volunteering with us.*

Are you available during the daytime on weekdays?*
—Please choose an option—YesNo

How much time would you like to volunteer per week? (Please note any preference for days / time)*

Have you got any allergies?*
—Please choose an option—YesNo

If yes, please state

Next of Kin Details

Full Name*

Relationship to you*

Telephone Number*

Email address*

Convictions

Have you ever been convicted, warned, reprimanded or cautioned for a criminal offence, or liable in a civil case?*
—Please choose an option—YesNo

If yes, please provide details (in strict confidence). You must disclose all previous convictions; none of these may be considered spent. As we work with vulnerable people, certain volunteer roles are exempt from the provisions of the Rehabilitation of Offenders Act 1974 and any convictions must be declared. Please note that certain volunteer roles will require a DBS check.

Please confirm that all the information given on this form is correct, and please also confirm that you have read and agree to the Volunteer Agreement on Confidentiality which is attached on the following page.