Volunteer Application Form

Do you manage an on-going or recurring physical condition or emotional/mental health problem which is likely to affect your volunteering or is there any information we may need to know in an emergency?

If yes, please give details. (NB. This will not exclude you from volunteering, but to help us to place you in an appropriate role.)

Skills and Experience

Have you previously undertaken any volunteering

If yes, please give details

Please tell us about your skills/experience that you see as relevant to volunteering

What do you hope to gain from volunteering with Thurrock and Brentwood Mind

Apart from English, please list any other language you speak.

What are your interests and hobbies?

References

Please provide us with details of 2 people who we can contact for references. E.g. Current employer, Clinical Supervisor, College Tutor, Personal reference (must have known you for two years or more. Please note we are unable to accept members of your family.)

Reference 1 Telephone

Relationship to you for Reference 1

Reference 2 Telephone

Relationship to you for Reference 2

Training

All volunteers will be asked to undertake training relevant to their role. This may be online but some training may be face to face.

Please indicate times you are available to attend.

Please indicate where you heard about volunteering opportunities at Thurrock and Brentwood Mind

Volunteer Counsellors

If you are applying to be a volunteer counsellor please complete this section. For all other roles please leave blank and move to the next section.

Current level of training

Date you qualified/qualify

Theoretical Orientation (CBT etc.)

Clinical Hours - Adult

Clinical hours - Child/young people

Do you have any personal experience of mental health, self / family / friends

Personal Therapist Name

Personal Therapist Address

Personal Therapist Email

Personal Therapist Telephone

Clinical Supervisor Name

Clinical Supervisor Address

Clinical Supervisor Email

Clinical Supervisor Telephone

Declaration of convictions

A Disclosure and Barring Service (DBS) check is undertaken as part of our volunteer screening process for roles that involve extensive contact with vulnerable adults of children. Please declare if you have any convictions, bind over orders or cautions. Under the Rehabilitation of Offenders Act (1975) and the R.O.A. (Exceptions) (Amendment) Order 1986, we ask you also to declare spent convictions. If you have any criminal convictions it will not automatically prevent you from doing any voluntary work for us, but we do need to know. Any information given will be kept in strict confidence.

Do you have any criminal convictions/bind over orders/cautions, either spent or unspect?

If yes, please provide details of each item including date and nature of conviction/bind over order/caution

Data Protection and Declarations

I confirm that the personal information in this form is accurate and complete. In accordance with the UK Data Protection Act 2018 and GDPR. I give my consent to Thurrock and Brentwood Mind for the purposes of my volunteering, to process my application and store the information on a secure database for no longer than is necessary. I also understand that it is my responsibility to keep the Project Manager informed of any changes to my personal details. I understand that my relationship with Thurrock and Brentwood Mind is not one of employment.

01375 391 411