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Volunteer Application Form

Personal details
Preferred Title:
First name:
Surname:
Address:
Date of Birth:
Email:
Work tel:
Home tel:
Mobile tel:
In case of emergency
Contact name:
Contact tel:
Contact Address:
How did you hear about Hospiscare?
Reference 1
Reference 1 Name:
Telephone
Address line 1
Address line 2
Town
County
Postcode
Email
How long have they known you?
In what capacity?
Reference 2
Reference 2 Name:
Telephone
Address line 1
Address line 2
Town
County
Postcode
E-mail
How long have they known you?
In what capacity?
Additional information
Please briefly state your reason for applying to be a Hospiscare volunteer and outline any past experience that is relevant:
I consent to the use of my personal data in the way described above:
Do you consider yourself to have a disability?
If yes, please tell us below what reasonable adjustment(s) you would require to the workplace to perform the role effectively and let us know if you have any special requirements with regards to the assessment process:
What role are you interested in volunteering? Eg. driving, gardening etc. (see a list of various roles on the website page). What days and times are you available?