Volunteer Application Form Step 1 of 4 25% Personal Details:Name* DrMissMrMrsMsProf.Rev. Prefix First Last Date of Birth* MM slash DD slash YYYY Home Address* Street Address Address Line 2 City County Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home Phone*Mobile Phone*Email* Volunteer RolesWhat sort of roles are you interested in? The Oakhaven website has details of the things that our volunteers help with and our current vacancies. Use the space below to let us know what role(s) you are interested in.What sort of roles are you interested in? The Oakhaven website has details of the things that our volunteers help with and our current vacancies. Use the space below to let us know what role(s) you are interested in. Supporting InformationUse this space to provide any information which may help to place you most successfully as a volunteer, including skills and interests. Please also state your reasons for wanting to volunteer and whether you are or have ever been involved with the Hospice, and in what capacity.Use this space to provide any information which may help to place you most successfully as a volunteer, including skills and interests. Please also state your reasons for wanting to volunteer and whether you are or have ever been involved with the Hospice, and in what capacity.How did you hear about volunteering at Oakhaven? Volunteer AvailabilityPlease tick the days and times when you would be available. Stating a preference is not binding.AM Select All Sunday Monday Tuesday Wednesday Thursday Friday Saturday PM Select All Sunday Monday Tuesday Wednesday Thursday Friday Saturday Could you be available at short notice if required?* Yes No Volunteers Aged Under 18Permission from and details of parent/guardian are required for applicants aged under 18Name of Parent / Guardian First Last Address of Parent / Guardian Street Address Address Line 2 City County Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Relationship Daytime PhoneEvening PhoneMobile PhoneEmail Declaration I give permission for my child to volunteer at Oakhaven Hospice. I understand that my details will be retained as next of kin/emergency contact for my child while s/he is volunteering. Volunteer Drivers OnlyCar Make & Model Reg No. Would you like to be considered to drive Oakhaven’s transport?(Sharan People Mover Automatic) Yes No • All drivers must have a full British driving licence. Their vehicle must have a current MOT certificate and tax disc (if applicable). • All drivers will be asked to produce written evidence that they have informed their insurance company of their intention to be a volunteer driver for Oakhaven Hospice Trust and that they have fully comprehensive insurance. A standard letter and return form will be provided so that you can comply with this condition. • Drivers are required to undertake a driving assessment with a Road Safety Officer from Hampshire County Council. This consists of an accompanied drive in your own vehicle lasting about an hour. The fee for the assessment will be paid by Oakhaven. • Fitness to drive is subject to a confidential review by the Occupational Health Department. • We require drivers to bring day patients to the Day Hospice on Mondays, Wednesdays, Thursdays and Fridays, to arrive at approximately 10.30am and to take patients home at 3.30pm. Sometimes in-patients also need transport home. Occasionally day trips, carers’ afternoons and coffee mornings are organised for which transport may be required. • If you use your own vehicle, a mileage allowance will be provided on completion of a monthly claim form. The catchment area for Oakhaven stretches approximately from Highcliffe in the west to Hythe/ Marchwood in the east, and from the Totton area in the north to Lymington in the south. Are you willing to cover all these areas? If no, state the area you are prepared to cover:• All drivers must have a full British driving licence. Their vehicle must have a current MOT certificate and tax disc (if applicable). • All drivers will be asked to produce written evidence that they have informed their insurance company of their intention to be a volunteer driver for Oakhaven Hospice Trust and that they have fully comprehensive insurance. A standard letter and return form will be provided so that you can comply with this condition. • Drivers are required to undertake a driving assessment with a Road Safety Officer from Hampshire County Council. This consists of an accompanied drive in your own vehicle lasting about an hour. The fee for the assessment will be paid by Oakhaven. • Fitness to drive is subject to a confidential review by the Occupational Health Department. • We require drivers to bring day patients to the Day Hospice on Mondays, Wednesdays, Thursdays and Fridays, to arrive at approximately 10.30am and to take patients home at 3.30pm. Sometimes in-patients also need transport home. Occasionally day trips, carers’ afternoons and coffee mornings are organised for which transport may be required. • If you use your own vehicle, a mileage allowance will be provided on completion of a monthly claim form. The catchment area for Oakhaven stretches approximately from Highcliffe in the west to Hythe/ Marchwood in the east, and from the Totton area in the north to Lymington in the south. Are you willing to cover all these areas? If no, state the area you are prepared to cover: Yes No Shop Volunteers OnlyPlease indicate the shop in which you would like to work: Select All Lymington Lymington Children Lymington Craft Hythe New Milton Shirley Fairview Totton Highcliffe Qualified Volunteers Only (eg therapists, counsellors)QualificationsPlease list your qualifications and any relevant post-graduate courses you have attended. Please include dates and details of training establishment:QualificationDatesTraining Provider / Establishment Do you belong to a professional association? Please provide details: Please outline what professional experience you have had including details of the types of clients you have worked with and in what setting: Health and Bereavement InformationWe rely on our volunteers to make sure they are medically fit to fulfil their duties. Many volunteer roles require several hours standing or walking. Please check with your doctor if in doubt. Volunteer drivers may be asked to provide additional information.Are you in good health?* Yes No Are you able to fulfil a shift which may mean you are on your feet for 2-4 hours?* Yes No Please provide details if you have any medical condition that could affect your volunteer placement: Have you suffered bereavement in the last two years?* Yes No Please use this space for any additional information you may wish to give:RefereesReferees*Please give details of two references who have known you for at least two years. These references must not be relatives. If you are a complementary therapist, please give details of a reference who knows you in a professional capacity.NameAddressPostcodeTel No.Email Criminal Records DisclosureCriminal Records DisclosureDue to the nature of our work, we are exempt from the 1974 Rehabilitation of Offenders Act and we therefore ask you to disclose any convictions, including those which are spent. Not all convictions have a bearing on whether you are suitable to volunteer. If we feel that your conviction is relevant to your application, we’ll discuss it with you. Please give details of any convictions here or on a separate page if necessary.Data ProtectionWe are legally obliged to hold certain information about you, such as address details, next of kin, age and hours of work. We promise your personal information will only be used by Oakhaven Hospice Trust and will not be passed on to any other organisations. You are entitled to see any information we hold about you. For full details of our Privacy Policy, please go to https://www.oakhavenhospice.co.uk/privacy-policyPolicies & ProceduresStaff and Volunteers are expected to make themselves aware of all relevant policies and procedures which are readily available — please ask Human Resources or Volunteer Services for further details.Health & SafetyAll volunteers are subject to an induction and training period. Volunteers are required to complete mandatory training (e.g. Fire Procedure, Moving & Handling, Health & Safety)Confidentiality & DeclarationDuring the course of your voluntary placement you are likely to have access to confidential information about the Hospice and its patients. This information must not be disclosed to third parties, either during or after the voluntary placement. Even the information that a person is a patient of the Hospice is confidential. Any breach of confidentiality during the voluntary placement will be viewed extremely seriously and appropriate action, which may include the termination of the placement, will be taken. If you are not sure if something is confidential please refer to the manager of the area in which you are working or ask the Volunteer Services Coordinator.Confidentiality I agree to the above Confidentiality requirement. I declare that I have read all the above notes and that the information on this form is true and complete to the best of my knowledge.44.192.114.3202/07/2022 Δ Alternatively you can download a PDF form to print and fill in: Volunteer Application Form 2020
