A Member of

A Member of: Essex Association of Volunteer Centres

First name		Surname
Address:

I agree to be contacted about volunteering. Yes/ No

Tel: (day)		Tel: (evening)
Mobile		E Mail
How did you hear about the Volunteer Centre?

Please take few minutes to look through the following lists to help us match you to a suitable opportunity.

Area Interest: Please tick appropriately (Who/what would you like to help?)		Type of Activity: Please tick appropriately (What would you like to do?)
Animals		Administration
Art and Culture		Advice Work and Counselling
Children		Architecture and Building Work
Disability		Art
Disaster Relief		Befriending
Domestic Violence		Business and Management
Drugs and Addictions		Campaigning and Lobbying
Education and Literacy		Caring
Elderly		Catering
Emergency Services		Community Work
Employment		Computers, Technology, Website Design
Environment		Counselling
Families		Driving
Health and Hospital and Hospices		Entertainment
Heritage		Finance Work
Homelessness and Housing		First Aid
Human and Civil Rights		Fundraising
International Aid and Disaster Relief		Gardening
Legal Aid and Justice		General & Helping
Mental Health		Hostel Work
Mentoring		Languages
Museums		Legal Work
Music		Local Events
Politics		Marketing and PR and Media
Prisoners and Ex-Offenders		Music
Race and Ethnicity and Refugees		National & International Events
Religion		Practical Work and DIY
Sport and Outdoor Activities		Retail and Charity Shops
Women's Groups		Sports Volunteering
Youth		Teaching, Training & Coaching
		Trusteeship & Committee work
		Under 16’s volunteering
Gay, Lesbian, Bi and Transsexual		Employee & Group Volunteering

Please give brief details of any previous voluntary work, skills, qualifications or experience.

Please indicate the times that you can volunteer. If flexible, please tick all.

	Mon	Tue	Wed	Thu	Fri	Sat	Sun
am
pm
evening

ALL THE FOLLOWING SECTIONS ARE OPTIONAL. THEY CAN BE LEFT BLANK BUT PLEASE SIGN THE FORM AT THE BOTTOM.

Age range (optional)

Under 15	15-18	19-25	26-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	Over 65

Please place a tick against your current employment status (optional)

Employed	Employed part time	Houseperson	Non-employed	Retired
Self employed	Student	Unable to work	Unemployed

Please place a tick against your ethnic background (optional)

Any other background	Indian	Pakistani	White British (English)
Bangladeshi	Other Asian	White & Asian	White British (Scottish)
Black African	Other Black	White & Black African	White British (Welsh)
Black Caribbean	Other Mixed	White & Black Caribbean	White Irish
Chinese	Other White	White British	Rather not say

Nationality		Do you consider yourself to be disabled?	Are you insured for volunteer driving?	Own Transport	Type of licence (Full, Provisional, HGV, Motorcycle
		Yes/ No	Yes/ No	Yes/ No

To the best of my knowledge and belief the information I have given is correct. This information will be treated as confidential and any relevant details will only be made available to another organisation with my permission. Involvement as a volunteer may require references and/or a Criminal Records Check, if appropriate.

Data Protection: I consent to the information on this form being held on file in accordance with the Data Protection Act 1998

Signed: …………………………………………………………………………..DATE:………………………..