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Personal Details (Hospice Volunteers 21yrs)

First Name *

Last Name *

Email Address *

Mobile Number *

Telephone Number

Address Information

Street Address *

Town *

County *

Country *

Postcode *

Skills and Qualifications

Please tell us why you want to volunteer for Derian House? *

Please tell us about any skills, experience, or personal qualities you have that you feel would be helpful in this role , whether gained through work, volunteering, or everyday life. *

Why do you think you’d enjoy or be well-suited to this volunteer role? *

Do you have any qualifications or training that you think would help you in this role? *

Rehabilitation of Offenders Act 1974 (Exceptions) Order

Derian House Children’s Hospice complies fully with the DBS Code of Practice and treats all applicants fairly. We will not discriminate unfairly against anyone based on a conviction or other information revealed in a criminal record check.

This role requires a DBS check at the level relevant to the position (Basic for Retail, Standard or Enhanced for Hospice volunteering). Checks are only carried out once suitability has been confirmed through the recruitment process.

At interview, or in a separate discussion, we will have an open conversation about any offences or other matters relevant to the role. Failure to disclose directly relevant information may result in withdrawal of a volunteer offer.

Please indicate if you have any spent cautions or convictions. (This information will only be used if you are successful in your application when the relevant DBS check is completed). * Yes No

Reference Details

All volunteer appointments are subject to satisfactory reference checks.

Please provide details of two referees who must have known you for at least two years, preferably in a work, education, or volunteer context. (Family members or Derian House staff cannot be accepted).

References will only be requested if your application is successful.

Reference One:

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

How do you know this person? (e.g. former Manager, College Tutor) *

Email (Mandatory as reference requests are emailed) *

Contact Number *

Reference Two:

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

How do you know this person? (e.g. former Manager, College Tutor) *

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 *

Do you currently work for us? * Yes No

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

I confirm that I am 21 years (or over) * Yes No

How did you hear about this volunteering role?

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.

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