1 Thorpe Close, London W10 5XL Tel: 020 8969 9105 Fax: 020 8969 5936
e-mail: firstname.lastname@example.org web: www.ackc.org.uk
Registered Charity Number: 1082658 Limited Company No: 3926026
VOLUNTEER APPLICATION FORM
Date: Date of Birth:
Tel Number: Email:
Person to Contact in an Emergency (for underage volunteers – optional for 18+
Where did you hear about Age Concern Kensington & Chelsea?
What is your particular objective in becoming a volunteer?
(e.g. self development; spare time interest; training opportunities).
What previous experience of voluntary involvement do you have, if any?
Please give a brief description of present or previous work experience, paid or
What specific life or work experience of older people do you have?
(N.B. It is not essential to have had any previous experience).
What are your interests/skills/hobbies?
Please state if you wish to share any of these within your voluntary role.
Do you speak any languages other than English? (Please state which)
Which Age Concern Kensington & Chelsea project(s) are you most interested in?
Referees: Please provide the names of two referees. Your referees must have
known you for at least one year, based in the UK and cannot be related to you
or live at the same address. At least one referee should be someone who
knows you in a professional capacity (eg employer, doctor etc). You will need
to provide with full postal address.
1. Name: 2. Name:
Tel. No.: Tel. No.:
CRIMINAL RECORD DECLARATION
Organisations working with vulnerable people are an excepted party under the
Rehabilitation of Offenders Act 1974. Volunteers with Age Concern Kensington &
Chelsea are required to declare any previous convictions, even those which would
normally be considered spent under the Act. Having a criminal record will not
necessarily exclude you from volunteering with Age Concern Kensington & Chelsea.
Do you have any previous convictions? YES NO
If you answered YES to the above question, what conviction(s) have you had, and
what was/were the date(s) of conviction(s)?
EQUAL OPPORTUNITIES STATEMENT
(See enclosed statement)
Age Concern Kensington & Chelsea is committed, in its working practice and in its
employment policy and practice, to actively oppose discrimination on the grounds of
race, culture, age, religion, sex, sexuality, disability, class or marital status. Sixty
Plus acknowledges and welcomes differences and we shall strive to develop equality
of opportunity at all levels of our working practice including service provision,
volunteer activity and recruitment procedures.
By signing this application form you agree, as a volunteer with Age Concern
Kensington & Chelsea to abide by these aims.
OPTIONAL ADDITIONAL INFORMATION
If there is any further information you wish to add in respect of your application
before attending an interview, please use this space
(e.g. health problems, cultural or other special requirements, languages spoken,
training you are currently undertaking).
Interview Notes For Office Use Only
Interviewed by: …………………………………….. Date: ………………