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Personal Details (Applicants must be 16yrs +)

First Name *

Last Name *

Email Address *

Mobile Number *

Telephone Number

Street Address *

Town *

County *

Country *

Postcode *

Skills and Qualifications

Why do you want to volunteer for Derian House? *

Please share any relevant skills or experiences that you feel may benefit this volunteering role *

Why do you feel this role is suited to you? *

Please detail any relevant qualifications you feel will benefit this role *

Criminal Convictions

As an organisation assessing applicants’ suitability for positions which are included in the Rehabilitation of Offenders Act 1974 (Exceptions) Order using criminal record checks processed through the Disclosure and Barring Service (DBS), Derian House Children's Hospice complies fully with the Code of Practice and undertakes to treat all applicants for positions fairly. Derian House Children's Hospice undertakes not to discriminate unfairly against any subject of a criminal record check on the basis of a conviction or other information revealed.

This role is subject to a Disclosure and Baring Service check at a level relevant to the role (this may be Basic check for Retail or a Standard check if volunteering in the Hospice). This check will only be carried out once suitability of role has been confirmed through the recruitment process.

At interview, or in a separate discussion, Derian House Children's Hospice ensures that an open and measured discussion takes place on the subject of any offences or other matter that might be relevant to the position. Failure to reveal information that is directly relevant to the position sought could lead to withdrawal of an offer to volunteer.

Please confirm that you are aware and understand that a relevant level DBS check is required and you will provide all appropriate information at the time of interview and/or during the processing of the DBS check.

I confirm I understand that this role is subject to an appropriate level DBS check *

Reference Details

All volunteer appointments are subject to satisfactory reference checks. Please supply details of two references who must have known you for at least two years and preferably from a work, education or volunteer capacity (no family or Derian House staff members will be accepted for your reference). References will only be obtained if you have been successful.

Reference one:

Full Name (Not a family or Derian House staff member) *

Relationship to you *

Email (Mandatory as reference requests are emailed) *

Contact Number *

Reference two:

Full Name (Not a family or Derian House staff member) *

Relationship to you *

Email (Mandatory as reference requests are emailed) *

Contact Number *

Important Information

I am applying for a voluntary position with Derian House Children's Hospice. I understand, should I be successful, that we have not entered into an employment contract and the terms are not legally binding.

I confirm that the information given on this form is correct and complete. I understand that any information later discovered to be incorrect may result in the termination of any arrangements made.

I agree that Derian House Children's Hospice may hold and use personal information and they will be retained in accordance with relevant Data Protection Legislation.

I have read the Privacy Policy available online (www.derianhouse.co.uk).

If I am accepted, I confirm that I will comply with Derian's Policies and Procedures where relevant and uphold the values of Derian House Children's Hospice.

I agree to all of the above statements *

I consent to Derian Houses' Volunteering Services contacting me regarding my volunteer application? * Yes No

Do you currently work for us? * Yes No

Do you currently access the services of Derian House? * Yes No

Derian House complies with the codes of practice issued by the Information Commissioner under the Data Protection Act 1998. All information given will be treated as confidential and will only use that information for the purpose in which it is provided for and the information provided is correct. Derian House is committed to the principals of equal opportunities and opposes all forms of unlawful and unfair discrimination. Please refer to our Privacy Policy for further information.

I confirm that I am 16 years and over * Yes No

How did you hear about this volunteering role? *

About My Application

I confirm I have the right to work in the UK
I confirm that my details are complete and correct
I confirm I have read and agree to Derian House Children's Hospice privacy policy