ABA VOLUNTEER INTEREST FORM

YOUR CONTACT DETAILS

First Name:

Surname:

Address:

Postcode:

Telephone:

Mobile:

Email address:
ABOUT YOU

Date of Birth:

Gender:

Do you have a valid driving licence?

Yes
No

Do you have your own transport?

Yes
No
Do you have any medical condition that we might need to know about?
Yes
No
Are there any special adjustments that you feel you'd need in order to volunteer with us?
Yes
No
EMERGENCY CONTACT

Please give the details of a person we can contact in the case of a medical or other emergency.

Name:

Relationship to you:

Home telephone:

Work telephone:

Mobile:

Email address:
What kind of voluntary work are you interested in?

There are various volunteering roles available within ABA. Please tick any of the following roles that you're interested in. If you have another idea of how you could help us, feel free to let us know.

Sighted guiding (helping visually impaired people to find their way)

Yes
No

One-to-one support with service users

Yes
No

Helping at regular groups for service users

Yes
No

Helping at occasional events with service users and members of the public

Yes
No

Office work and administration

Yes
No

Publicity/Fund raising

Yes
No

Leading group sessions for service users (e.g. dancing, exercise, art, learning)

Yes
No

Reading to visually impaired service user. (Please tell us what languages you can read in)ing)

Yes
No

Driving

Yes
No
SKILLS AND EXPERIENCE

Please tell us about any skills or experience you already have, that you feel are relevant to the role:

Please tell us what skills you hope to learn or improve by doing voluntary work:

AVAILABILITY

How many hours per week could you offer?

Which days of the week are you normally available?

Mon
Tue
Wed
Thu
Fri
Sat
Sun

AM

PM

I can hereby commit to ......... hours per week for a minimum of 6 months.

Please state what area of interests you have (hobbies etc)

REFERENCES: Please give the name and address of two people who would be willing to act as referees

Name :

Position :

Address :

Name :

Position :

Address :

Phone no :

Email :

Phone no :

Email :

Signature :

Date :

TO BE COMPLETED BY APPLICANTS

Charity No 1042621

CHECK ON CONVICTIONS OR CAUTIONS

ABA work with vulnerable adults. This means that we are required to carry out police checks. Offences do not necessarily mean that you can't work for us.

A check as to the existence and content of a criminal record will be requested from the Disclosure and Barring Service after a person has been selected for appointment to this post. Refusal to agree to a check being made could disqualify you from being considered for the appointment.

You are therefore asked to sign the statement below to confirm your agreement, if you are selected for the appointment, to a check being made on any criminal record applicable to you.

ABA is discharging a social service function, and in this connection you are therefore obliged to disclose both current and spent convictions, including any cautions.

Please give details below of all convictions, cautions, reprimands or warnings (whether spent or not)

I agree, if I am selected for this appointment, to checks being made with the Disclosure and Barring Service for any record of convictions or cautions against me. I am aware that such information as appropriate for Standard/Enhanced Disclosures will be made available.

I consent to ABA carrying out appropriate checks with the Disclosure and Barring Service.

Name (please print):

Signature:

Date:

Thank you for completing this form.
Please return it with your application form to:
Association of Blind Asians Leeds, Touchstone Support Centre, 53-55 Harehills Avenue, Leeds, LS8 4EX

Our Funders

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