AUNTIE PAM’S VOLUNTEER 
APPLICATION FORM

Thank you for your interest in becoming a Volunteer at Auntie Pam’s.  Please complete this application form and return it to the address on page 4 or email to auntiepams@kirklees.gov.uk  

Please complete in BLOCK CAPITALS
PERSONAL DETAILS	
Title:	Mr    Mrs    Miss    Ms    	
Forename:	     	Surname:	     	
	Are you over 18?	Yes / No	
Address:	     	
	     	Telephone numbers	
	     	Home :	     	
Postcode:		Mobile:		
Email address      	

EMPLOYMENT STATUS	
Are you: 		
Currently employed?	Yes    No 	
In higher education?	Yes    No 	
Retired from employment?	Yes    No 	

WHICH VOLUNTEER ROLE ARE YOU APPLYING FOR:	
Peer Support Volunteer
As this is a peer support role, you will need to have given birth and have experience as a mother.		
Meet and Greet Volunteer
		
Swap Shop Volunteer

WHICH CENTRE WOULD YOU LIKE TO BE BASED AT?	
Huddersfield (New Street, Huddersfield) 
Tuesday, Wednesday or Thursday		
Dewsbury (9 Northgate, Dewsbury) 
Monday, Wednesday or Friday		

Please indicate when you are able to help	
Morning 	Afternoon 	Evening 	Full day 	

VOLUNTEERING INFORMATION	
Do you have any past or present voluntary experience?	Yes 	No 	
If yes, please give details:	

	
Why do you wish to undertake voluntary work within Auntie Pam’s?	

	

How did you hear about volunteering with Auntie Pam’s?	
Newspaper 	Poster 	Friend 	Website 	
Volunteer bureau 	Present volunteer 	Other 	

LANGUAGES	
First language spoken:	     	
Other language spoken:	     	

REFEREES	
Please indicate below the names and addresses of two referees, (NOT RELATIVES) who may be contacted:	
Referee 1:	
Title:	Mr    Mrs    Miss    Ms    		
Forename:	     	Telephone numbers	
Surname:	     	Home :	     	
Address:	     	Work :	     	
	     		
	     	Postcode:	     	
Are you known by any other name by this referee?   Yes    No 	
If yes, please type other name here:	

Referee 2:	
Title:	Mr    Mrs    Miss    Ms    Rev 		
Forename:	     	Telephone numbers	
Surname:	     	Home :	     	
Address:	     	Work :	     	
	     		
	     	Postcode:	     	
Are you known by any other name by this referee?   Yes    No 	
If yes, please type other name here:	     	

OTHER INFORMATION	
Please use this space to tell us any other information you think we would like to know:-	

	

CONFIDENTIALITY 	
All volunteers are asked to sign an agreement to maintain confidentiality, with regard to any personal/medical details about residents/clients before commencing voluntary work.
	
Signature:
	Date:
	     

Please read the following information carefully and sign below as directed.

If whilst a volunteer you are police cautioned, given final warning or reprimanded or are subject to any police investigation you must inform the Auntie Pam’s Service Co-ordinator immediately.

DATA PROTECTION ACT

As you have provided personal information to Kirklees Council on your application for voluntary service at Auntie Pam’s, this form seeks your consent for us to use the information provided.  General Data Protection Regulations UK sets out certain requirements for the protection of your personal information against unauthorised use or disclosure.  The Act also gives you certain rights.

I am happy to give the personal details required for processing this form. I understand that they will be stored until the end of the recruitment process. At which point they will be destroyed immediately, unless my application is successful. In which case they will be stored for 2 years from the date I leave the volunteering role.

I understand that they will be used during the recruitment process, will form the basis for your personal volunteer record and will not be shared with anybody other than Kirklees Council. I understand that I can withdraw or update my details at any time. For more information about how we store your data and how you can request your right to withdraw consent to use your personal data later please see http://www.kirklees.gov.uk/beta/information-and-data/how-we-use-your-data.aspx 

Volunteer Privacy Notice can be found at www._____________

Signature: __________________________________

Full Name (printed): __________________________

Date: _______________________________________

Thank you for completing this form!  

Please Return to:
FREEPOST RTAY-XJZK-STGL
Lisa Akester
Auntie Pam’s
9 Northgate
Dewsbury
WF13 1DS

Or email to: auntiepams@kirklees.gov.uk 

Electronic versions of the application form are available by emailing: auntiepams@kirklees.gov.uk or by visiting our website www.auntiepams.org.uk

This page has been left blank intentionally.  Please see page 7.

This data is used for monitoring purposes and is made anonymous and collected with the express consent of Auntie Pam’s volunteers which can be withdrawn at any time.  Auntie Pam’s volunteers are entirely free to decide whether or not to provide such data and there are no consequences of failing to do so. 

Race relations (Amendment) Act 2000

*	   I would describe my ethnic origin as:	

Asian or Asian British
 Bangladeshi                        
 Indian
 Pakistani
 Any other Asian background

Black or Black British
 African
 Caribbean
 Any other Black background
	
Mixed
 White & Asian
 White & Black African
 White & Black Caribbean
 Any other mixed background

White
 British 
 Irish
 Any other White background
	
Other Ethnic Group
 Chinese
 Any other ethnic group

 I do not wish to disclose this

Equality Act (Sexual Orientation) Regulations 2007

*	  Please select the option which best describes your sexuality	
 Lesbian
 Gay
 Bisexual	
 Heterosexual
 I do not wish to disclose this

Equality Act 2006

*       Please indicate your religion or belief
	
 Atheism                            
 Buddhism                         
 Christianity                       
 Islam                                	 Jainism
 Sikhism
 Other	 Hinduism
 Judaism
 I do not wish to disclose this	

Disability Discrimination Act 2005

	* Do you consider yourself to have a disability?	 Yes                                              I do not wish to disclose this           
 No