Radio Chelsea and Westminster Application form
Volunteer application form, please answer every question.
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Title
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Choose
Mr
Mrs
Miss
Ms
other
First Name
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Your answer
Surname
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Your answer
Date of Birth
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Address
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Your answer
Postcode
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Your answer
Telephone
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Your answer
E-mail address
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Your answer
What is your current employment / availabilty?
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Your answer
What interests you about hospital radio
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Your answer
Describe a situation where you have helped someone in need. (this may be as part of previous voluntary work or within your private life). What action did you take?
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What was the situation?
Your answer
What was the outcome
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What was your action and what was the outcome
Your answer
What might you bring to the station over and above voluntary duties?
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Your answer
Please indicate if you have ever worked with any of the following
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select as many as required
Children
The elderly
People with mental health problems
the physically or sensory impaired
Have you ever volunteered before?
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Yes (if yes, please complete the below)
No (if no, please scroll down to references)
Name and address of previous Organisation / Charity
Your answer
Main Duties
what did you do at the organisation / charity
Your answer
From
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To
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Name and address of previous Organisation / Charity
Your answer
Main Duties
what did you do at the organisation / charity
Your answer
From
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YYYY
To
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Please give details of two people who we may approach if called for interview and who are able to provide references relating to your experience and suitability to this post. The referees should be your two most recent employers (including voluntary work) including your current one and must hold positions of direct responsibility relative to you (friends and family may not be submitted as referees.) REFERENCE 1 :
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First Name
Your answer
REFERENCE 1
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Surname
Your answer
REFERENCE 1
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Address
Your answer
REFERENCE 1
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Telephone
Your answer
REFERENCE 1
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Relationship to you (e.g Line manager, work colleague etc.)
Your answer
REFERENCE 2:
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First Name
Your answer
REFERENCE 2
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Surname
Your answer
REFERENCE 2
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Address
Your answer
REFERENCE 2
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Telephone
Your answer
REFERENCE 2
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Relationship to you (e.g Line manager, work colleague etc.)
Your answer
Emergency contact details: - please give details in case of an emergency
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Name
Your answer
Address
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inc. postcode
Your answer
E-mail
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Your answer
Telephone
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landline and mobile
Your answer
Relationship to you
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Your answer
Are you related to a member or officer within Chelsea and Westminster Hospital NHS foundation Trust ?
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Yes
No
Have you previously worked or volunteered within Chelsea and Westminster Hospital NHS foundation Trust
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Yes
No
Are you legally entitled to work in the UK
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Yes
No
REHABILITATION OF OFFENDERS ACT 1974 I confirm that to the best of my knowledge the details given are correct. I understand that the post applied for is NOT protected by the Rehabilitation of Ofenders Act 1974 and that I must disclose all information about all convictions (if any) in a Court of Law, no matter when they occurred. Due to the special nature of some posts, prospective volunteers will be subjected to a Criminal Record Bureau check.
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ARE YOU CURRENTLY BOUND OVER OR HAVE YOU EVER BEEN CONVICTED OF A CRIMINAL OFFENCE IN THE UK OR IN ANY OTHER COUNTRY?
Yes
No
By completing the next section you you understand and agree to the below text
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In accordance with the 1998 Data Protection Act it is agreed that CHELSEA AND WESTMINSTER HOSPITAL NHS FOUNDATION TRUST may hold and use personal information about me for placements reasons and to enable CHELSEA AND WESTMINSTER HOSPITAL NHS FOUNDATION TRUST to keep in touch with me. This information can be stored in both manual and/or computer form, including the data in section 2 of the Data Protection Act 1998. I understand that in order to be considered for placement as a volunteer I will be asked to produce evidence of identification, address, and status in the UK when applicable. I understand that my ID Badge is property of CHELSEA AND WESTMINSTER HOSPITAL NHS FOUNDATION TRUST and when I stop volunteering I have to surrender my ID Badge to the Volunteer Liaison Manager. I understand that in accordance with CHELSEA AND WESTMINSTER HOSPITAL NHS FOUNDATION TRUST policy, if I do not come into CHELSEA AND WESTMINSTER HOSPITAL NHS FOUNDATION TRUST to volunteer for longer than thirteen consecutive weeks, I will have to re-apply in order to join the volunteers’ team again. I declare that the information given on this form is true and complete. I understand that any false information may result in the withdrawal of any offer of voluntary role or my dismissal if accepted as a volunteer.
Yes, I agree
Please confirm you agree to this by confirming your name
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Full Name
Your answer
Confirm today's date
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MM
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Submit
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