Furniture Service Volunteer form

Name *

Address *

Telephone number *

Email address *

Tenure - Are you:

Stockport Homes tenant

Private tenant

Housing association tenant

Owner occupier

Which days of the week are you available to volunteer? Please specify if you are available morning / afternoon. *

How many hours would you like to commit per week? *

How long can you commit to a role? Please tick. *

0-3 months

3-6 months

6-12 months

Over 12 months

Referee 1

These will not be contacted unless you give permission.

Name *

Address *

Phone number *

How do you know this person? *

Referee 2

These will not be contacted unless you give permission.

Name *

Address *

Phone number *

How do you know this person? *

Other (please state)

Please tell us about any skills, previous experiences and interests you have that will be useful in the volunteer role. For example, previous work or voluntary experiences, IT skills, communications skills, languages you speak, your hobbies and interests. *

Please tell us about any skills or interests that you would like to develop as part of volunteering. *

Please tell us about any future career plans / goals.

Please tell us about why you want to volunteer with the Furniture Recycling Scheme *

Driving questions

Please answer the questions below if you are volunteering for a role that involves driving.

Do you drive? *

Yes

Do you have use of a car? *

Yes

Have you had any endorsements or accidents in the last five years? *

Yes

Have you been disqualified from driving? *

Yes

Do you suffer from any physical or mental health needs notifiable to DVLA? *

Yes

Additional requirements

Do you require any assistance or special arrangements to attend an interview or to enable you to volunteer? Please give details. *

Rehabilitation of Offenders Act 1974

Have you been convicted of a criminal offence (as defined by the Rehabilitation of Offenders Act 1974)? Full details of the requirement to disclose criminal convictions can be found at: www.legislation.gov.uk/ukpga/1974/53 *

Yes

Declaration

I confirm that the information given on this form is accurate to the best of my knowledge.

Signature *

Date *

Monitoring information

We aim to treat all volunteers equally, regardless of race, colour, ethnic or national origin, religion, sexuality or disability. To check we are doing this and to check where there may be gaps in our service, please will you give us the following information. Your answer will be treated in the strictest confidence.

Age group *

16-24

24-44

45-59

60-64

65-74

75 and over

Gender *

Male

Female

Other

Prefer not to say