ࡱ> 9 bjbj hhw \ \ 8:\ )^___")$)$)$)$)$)$),/$)="_$)9) :") ") T&'%Q|p'")O)0)'";0;0D''&;0'4_) t-___$)$)$ ___);0_________\ X :  CONFIDENTIALVOLUNTARY SERVICES DEPARTMENT VOLUNTEER APPLICATION & REGISTRATION FORM Please complete ALL 3 pages using CAPITAL LETTERS PERSONAL DETAILS Title: Surname: First Names: Address: Post Code: Date of Birth Mr/ Mrs/ Ms/ Miss Other .. .. .. .. .. ..  Telephone (Home): Mobile No. E mail address Name & Address of Next of Kin Telephone No. of Next of Kin Relationship to Next of Kin . . . . . In order to be compliant with GDPR, please indicate how you wish to be contacted (please tick all relevant) Telephone: Home (, Mobile (, email (, or post ( HOW MUCH TIME ARE YOU ABLE TO DEVOTE TO VOLUNTARY SERVICES?SundayMondayTuesdayWednesdayThursdayFridaySaturdayMorningAfternoonEvening REFERENCESPlease give the name and address of two referees who have agreed to supply references. These may include your line manager, or someone in a position of responsibility who can comment on your work experience, competence, personal qualities, and suitability for the post. If you are a student please provide contact details of a teacher at school, college, or university. Please note that family members and relatives, or members of staff at 69ʪ District Hospital are not acceptable. We will accept a postal address if no e-mail is available. Please provide this in Supporting Information. Referee 1 Referee 2 NAME NAME. EMAIL ADDRESS EMAIL ADDRESS . RELATIONSHIP .. RELATIONSHIP ..  SUPPORTING INFORMATIONPlease provide additional information about yourself, this can include relevant knowledge and experience suitable for a volunteering post.  If you know which Department you would like to volunteer with, please provide details below   CONFIDENTIALITYPLEASE READ CAREFULLY. DO NOT SIGN UNLESS FULLY UNDERSTOOD: I understand that in the course of my service I may come to be in possession of information of a highly confidential nature concerning clients, patients, and staff of 69ʪ. I undertake not to divulge any information concerning clients, patients and staff or former clients, patients, and staff to unauthorised persons, and if in any doubt on answering a particular enquiry I will refer the matter to the head of department, senior manager or member of staff, or the Voluntary Services Manager, in particular, telephone conversations and electronic communications should be conducted in a confidential manner. Confidential information must NOT be disclosed to unauthorised parties without prior authorisation. Volunteers must NOT process any personal information in contravention of the DATA PROTECTION ACT 2018 and GDPR 2018. SIGNED: ....  DATE: .. Please ask your parent/guardian to complete this section if under 18. I understand the nature of the voluntary work applied for and give consent for .. .. (name of young person) to undertake this placement And (please tick as appropriate) ( I consent to them travelling to and from the Hospital/place of volunteering on their own Or ( I will be arranging for them to be dropped off and collected Signed: parent/guardian (delete as appropriate) Contact Telephone Number (in case of emergency):  Please return this form to Voluntary Services Department, 69ʪ District Hospital, 69ʪ, Wiltshire, SP2 8BJ EQUAL OPPORTUNITIES MONITORING IMPORTANT Because of the nature of volunteering in health and social care, exemption under the Rehabilitation of Offenders Acts applies. HAVE YOU EVER BEEN CONVICTED OF AN OFFENCE? YES / NO A full police screening check will be required for all applicants; the post will be subject to a satisfactory check being received by the Voluntary Services Manager. HEALTH DETAILS Do you have any disabilities? (please list)   Are you registered disabled?  YES / NO I UNDERSTAND THAT I WILL BE REQUIRED TO COMPLETE A HEALTH QUESTIONNAIRE AND MAY HAVE TO ATTEND A HEALTH CHECK PROVIDED BY THE TRUST.  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