Application Form Greenwich Cruse

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0 height="100%"><tr> <td valign="top" width=200 BGCOLOR="#FFCCFF" TEXT="#080000"> <div> <IMG SRC="07f889d0.jpg" border=0 width="136" height="157" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <DIV ALIGN="LEFT"></DIV> <div> <B>Greenwich Cruse</B></div> <div> <B>Site Navigation</B></div> <div> <A HREF="index.htm" TARGET="_top" TITLE="Greenwich Cruse"><U><IMG BORDER="0" SRC="Symb075c00b700c800000000.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Home</U></A></div> </td> <td valign="top" BGCOLOR="#FFFFFF" TEXT="#080000"> <div> Greenwich Cruse</div> <div> Cruse Bereavement Care<B>  </B><FONT SIZE="2" COLOR="#990099" FACE="Arial" ><B>St Lukes Hall, Westmount Road, London SE9 1JB</B></FONT></div> <div> <B>020 8850 9429</B></div> <div> <A HREF="mailto:mail@greenwichcruse.co.uk" TARGET="_top" TITLE="mailto:mail@greenwichcruse.co.uk"><U><B>greenwich@cruse.org</B></U></A></div> <div> <B>   </B></div> <DIV ALIGN="LEFT"></DIV> <div> <B>Print off this form and post it to us at the address above, </B><FONT SIZE="4" COLOR="#990099" FACE="Arial" ><B>or select text below and copy it into a Word document, fill in the details and email it back to </B></FONT><FONT SIZE="4" COLOR="#990099" FACE="Arial" ><A HREF="mailto:mail@greenwichcruse.co.uk" TARGET="_top" TITLE="mailto:mail@greenwichcruse.co.uk"><U><B>greenwich@cruse.org</B></U></A></FONT></div> <bR> <div> <B>CONFIDENTIAL</B></div> <div> <B>Greenwich Cruse Bereavement Care</B></div> <div> <B><U>BEREAVEMENT VOLUNTEER  </U></B></div> <div> <B>APPLICATION FORM</B></div> <bR> <div> <B>If you require this application form in large print or in audio tape format, please contact the office on 020 8850 9429.</B></div> <bR> <div> <I><B>COURSE DATES 2010:</B></I></div> <div> <I><B>Saturdays 23 Jan, 30 Jan, 6 Feb, 27 Feb, 20 Mar (9.30 - 4.30) at Greenwich Cruse combined with Tuesday evenings, 26 Jan, 2 Feb, 9 Feb, 23 Feb, 2 Mar, 9 Mar (7-10pm).</B></I></div> <bR> <div> <I><B>Course cost is £250 but this can be paid in instalments, and there are some concessionary places for those on low incomes.</B></I></div> <div> <I><B>Punctual attendance is expected on all days and there is a minimum session attendance requirement of 90% in order to be considered to pass the course.</B></I></div> <bR> <div> Thank you for offering to volunteer your time and skills to Cruse.  The work of Cruse depends on people who are prepared to offer quite an amount of time and energy - usually involving powerful feelings surrounding life and death.  This form is designed to help us - and you -  to see whether you are currently in a position to undertake such a commitment.  Cruse Bereavement Volunteers will be in contact with people who may be vulnerable, therefore our selection procedures reflect the need to safeguard the interests of our clients and volunteers.</div> <div> PLEASE READ THE LEAFLET `GIVE CRUSE A HAND' AND ALSO `INTERESTED IN BECOMING A COUNSELLOR FOR THE CityplaceGREENWICH BRANCH OF CRUSE'  BEFORE COMPLETING THIS FORM.</div> <bR> <div> <B>THE MORE INFORMATION YOU CAN GIVE US THE BETTER.  THANKS.</B></div> <bR> <div> DATE:     /      / 20__</div> <bR> <div> NAME <U>                                                  </U></div> <div> ADDRESS <U>                                                                                               </U></div> <div> POSTCODE <U>                    </U></div> <div> DATE OF BIRTH:</div> <div> HOME PHONE:</div> <div> WORK PHONE:</div> <div> MOBILE PHONE:</div> <div> E-MAIL ADDRESS:</div> <bR> <div> <B>TAKING CARE OF OURSELVES AND OTHERS</B></div> <div> Cruse aims to help people come to terms with loss and change when somebody has died.  In order to work most effectively with our clients, bereavement volunteers do not usually undertake client work if they have had a recent close bereavement.  This is because their own powerful feelings might make it difficult for them to separate their own grief from that of their client's.  By working in this way, we safeguard both our clients and our workers.  If you have had a recent significant loss, you may still be able to help Cruse.</div> <bR> <div> Do you have your own transport?                               YES /NO</div> <bR> <div> Are you fluent in any language other than English?  If so, which?</div> <bR> <div> Do you consider you have a disability?                          YES / NO</div> <div> (Please see Equal Opportunities Form)</div> <bR> <div> If YES do you have any specific needs to be met at interview?</div> <bR> <div> <B>Bereavements:</B>  Please tell us about any significant personal bereavement you have had in the past five years - and how you feel this is continuing to affect you.</div> <bR> <bR> <bR> <bR> <bR> <div> <B>Health and well-being issues:</B></div> <div> Working with bereaved people may place considerable and understandable stresses on our energy levels, physical health and mental well-being.  Have you had any health or mental well-being problems in recent years which might affect your capacity to work with us?  A disability or health problem will not prevent full consideration of your application.</div> <bR> <bR> <bR> <bR> <bR> <div> <B>TRAINING AND COMMITMENT AS A BEREAVEMENT VOLUNTEER:</B></div> <div> You will spend about 8 hours a month working with bereaved clients on a one-to-one basis.  After a trial period with one client, or about three months, you make a commitment to a minimum of one-year of client work.  Work may take place on site or else in the client's home.</div> <div> You will need to undertake the 48 hour AWARENESS IN BEREAVEMENT CARE course (cost £250 - usually a late April to mid July course).   Before and after your training you will be interviewed.  THERE ARE USUALLY FEWER PLACES THAN THERE ARE APPLICANTS.  If you are selected, you will be invited to join a supervision group.  It is mandatory that you attend ten of the twelve supervisions a year.  These last two hours, once a month.  Initially you will work with one or two clients in agreement with your supervisor, and according to your experience.  You will commit to doing client work throughout your first year at Cruse.</div> <bR> <div> <B>WORK</B></div> <div> It is surprising how even a couple of hours a week can become quite a commitment, Especially if you have a busy work or personal schedule.  </div> <div> Realistically you need to be able to set aside about  three hours a week, as well as one evening a month for supervision.  In addition you will be expected to attend all branch in-house training.</div> <div> Do you think you can do this?</div> <bR> <bR> <bR> <div> <B>PLEASE ANSWER THESE QUESTIONS AS FULLY AS POSSIBLE - USE MORE SHEETS IF NECESSARY:</B></div> <bR> <div> <B><U>WHAT I WANT TO BRING TO CRUSE</U></B></div> <div> <B>Tell us why you want to be a Bereavement Volunteer for Cruse.  </B></div> <bR> <bR> <bR> <bR> <bR> <bR> <bR> <div> <B>What skills or experiences do you feel you might bring from your life and work which would be useful to Cruse?</B></div> <bR> <bR> <bR> <bR> <bR> <bR> <bR> <bR> <div> <B>What is important for you about the work of Cruse?</B></div> <bR> <bR> <bR> <bR> <bR> <bR> <div> <B>QUALIFICATIONS AND PRACTICAL EXPERIENCE RELEVANT TO             BEREAVEMENT WORK & COUNSELLING</B></div> <bR> <div> <B>If you have any qualifications or training in counselling please indicate the title, duration, date and place of your training.</B></div> <bR> <bR> <bR> <bR> <bR> <bR> <bR> <div> <B>EXPERIENCE:  What, if any, experience do you have of working with clients in a counselling situation?</B></div> <bR> <bR> <bR> <bR> <bR> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B>DISCLOSURE OF CONVICTIONS</B></div> <div> <U>(Rehabilitation of Offenders Act 1974)</U></div> <bR> <div> <B>Many positions within Cruse Bereavement Care involve working with vulnerable people, therefore, all applicants will be required to apply for a Disclosure from the Criminal Records Bureau.  Having a criminal record will not necessarily bar you from volunteering.  This will depend on the nature of the position and the circumstances and background of your offences.</B></div> <bR> <div> Have you ever been convicted of a criminal offence or been given a caution, reprimand or warning?                                             YES / NO</div> <bR> <div> <B>If YES, </B>details including type of offence, date, sentence, fine etc. are required from you and <B>should be included in a separate sealed envelope.  </B>This information will only be disclosed to those involved in the selection process.</div> <bR> <bR> <div> <FONT SIZE="4" COLOR="#000000" FACE="Arial" >BANKRUPTCY</FONT><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT>(<FONT SIZE="2" COLOR="#000000" FACE="Arial" >only applies if being considered as a potential Chairperson or Treasurer</FONT>).</div> <div> Bankruptcy will not prevent full consideration of your application.</div> <bR> <div> Have you ever been declared bankrupt?                    YES / NO</div> <bR> <div> Have you ever been director of a company that has gone into compulsory liquidation?</div> <div>                                                   YES / NO</div> <div> If YES to either question, please give details in a separate sealed envelope as above.</div> <bR> <bR> <div> <B><U>REFEREES</U></B></div> <bR> <div> Please give the names and addresses of two people who have known you for some time (not relatives) and are willing to act as referees.  One of these could be your current or previous employer.</div> <bR> <div> Name                              Name    </div> <bR> <div> <B>Address                         Address</B></div> <bR> <div> <B>Postcode                         Postcode </B></div> <bR> <div> <B>Tel No.                          Tel No. </B></div> <bR> <div> <B>In what capacity does this referee know you?           In what capacity does this referee know you?     </B></div> <bR> <div> <B>                         </B></div> <bR> <bR> <bR> <bR> <div> DECLARATION</div> <div> <B>To the best of my knowledge, the information I have given on this form is correct and complete.  I understand that it may be kept on a computer file and that it will not be divulged to any other organisation.  I understand that if any information is later discovered to be incorrect, this may result in my no longer being able to work with Cruse Bereavement Care.</B></div> <bR> <div> <B>Signed: ________________________   Date: ________________________</B></div> <bR> <bR> <bR> <bR> <div> <B>Please return this form to:</B> Greenwich Cruse Bereavement Care, St. Luke's Hall, StreetaddressWestmount Road, CityLondon PostalCodeSE9 1JB</div> <bR> <bR> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B>EQUAL OPPORTUNITIES MONITORING FORM</B></div> <bR> <div> IN CONFIDENCE</div> <div>      Cruse Bereavement Care wants to draw its volunteers from all sections of the community.  Please help us by filling in this form.  The information will be treated confidentially and only used to monitor the effectiveness of our Equal Opportunities Policy.  To ensure anonymity this form should be returned in a sealed separate envelope. </div> <div>      <U>MANY THANKS.</U> </div> <bR> <bR> <div> 1.     Gender:  (please circle)          MALE                   FEMALE</div> <bR> <div> 2.     Age:        16-17     18-29     30-39     40-49     50-59     60-74     75+</div> <bR> <div> Do you consider yourself to have a disability as described by the Disability Discrimination Act?  i.e. do you consider yourself to be someone who has a physical or mental impairment which has a substantial and long-term adverse effect on your ability to carry out normal day-to-day activities?  (Please circle).</div> <DIV ALIGN="LEFT"></DIV> <div> YES                    NO</div> <div> How would you describe your ethnic or cultural origin?  (Please circle).  If you wish to classify yourself in some other way, please feel free to do so.</div> <bR> <div>      Asian British               Chinese</div> <div>      Bangladeshi               Indian</div> <div>      Black African               Mixed Race</div> <div>      Black British               Pakistani</div> <div>      Black Carribean          Other (please specify)</div> <div>      Black Other               White British</div> <div>      White Irish               White Other</div> <bR> <div> Do you consider yourself to have a religious affiliation?     (Please circle).</div> <DIV ALIGN="LEFT"></DIV> <div> YES                     NO</div> <div> If yes, how would you describe it? </div> <bR> <bR> <bR> <div> <I>EQUAL OPPORTUNITIES POLICY STATEMENT</I></div> <bR> <bR> <div> Cruse Bereavement Care aims to offer to all throughout the placecountry-regionUnited Kingdom a service which includes counselling, advice and opportunity for social contact.</div> <bR> <div> Its policy is to ensure equal access to this service for all who wish to use it and for all who wish to offer it, whether as volunteers or as paid staff, regardless of gender, age, disability, religion, marital status, sexual orientation, colour or race.</div> <bR> <div> Cruse's aim is to establish equal opportunity and social justice in all areas of its activities by creating a working environment in which maximum value is accorded to the resources and needs of all people.</div> <bR> <div> To this end, Cruse is also working towards fulfilling the legal opportunities set out in the relevant legislation including the Race Relations Act, the Equal Opportunities Act, the Equal Pay Act and the Disabled Persons Employment Act.</div> <bR> <div> Cruse is in the process of introducing a Code of Practice relating to the recruitment, selection and training of paid staff and volunteers, working conditions and monitoring of procedures to implement this policy.</div> <bR> <bR> <div> <U>Info/stat/eqopstf.mon</U></div> <bR> <div> OFFICE USE ONLY</div> <bR> <div> Action taken on receipt of this form:</div> <bR> <bR> <div> Further comments:</div> <bR> <bR> <div> Interview date:</div> <bR> <div> CRB commenced:</div> <bR> </td> </tr></table></body>