Greenwich Cruse

Cruse Bereavement Care  St Lukes Hall, Westmount Road, London SE9 1JB

020 8850 0505

greenwich@cruse.org

Print off this form and post it to us at the address above, or select text below and copy it into a Word document, fill in the details and email it back to greenwich@cruse.org

CONFIDENTIAL

Greenwich Cruse Bereavement Care

BEREAVEMENT VOLUNTEER APPLICATION FORM

Thank you for your interest in the being a volunteer with Greenwich Cruse.  Please complete the details below.  The completion of this form may require you to give more information than you expected.  Most Cruse 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 our volunteers.

Please read the leaflet Give Cruse a Hand before completing the form.

SECTION ONE:  

SURNAME  ___________________________________     TITLE ________________

PREVIOUS SURNAME (S) ___________________________________________________

FIRST NAME  ______________________________________________________________

ADDRESS _________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

POSTCODE ___________     TEL NO (day)  _______________(evening) _______________

FAX NO ______________     E-MAIL   __________________________________________

AGE:

How did you hear about Cruse Bereavement Care?

Have you ever had contact with a Branch of Cruse Bereavement Care?

If YES please give details.

Please tell us why you want to volunteer for Cruse Bereavement Care.

What are the qualities you could bring to our work?

What experience could you bring?

Please list any relevant volunteer work or paid employment.

PERSONAL DETAILS

(A disability or health problem will not prevent full consideration of your application).

Have you had a close personal bereavement in the last 2 years?          YES / NO

If YES please say when.

Do you have your own transport?                               YES /NO

Are you fluent in any language other than English?  If so, which?

Do you consider you have a disability?                          YES / NO

(Please see Equal Opportunities Form)

If YES do you have any specific needs to be met at interview?

If your application is successful, we will need to know of any health condition which may affect your ability to work with clients.

What experience do you have of personal help, counselling or therapy given or received?

Please give details of any relevant training experience.

Please give details of relevant group work or supervision experience.

DISCLOSURE OF CONVICTIONS

(Rehabilitation of Offenders Act 1974)

Many positions within Cruse Bereavement Care involve working with vulnerable people, therefore, all applicants to roles involving client contact and on management committees 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.

Have you ever been convicted of a criminal offence or been given a caution, reprimand or warning?                                             YES / NO

If YES, details including type of offence, date, sentence, fine etc. are required from you and should be included in a separate sealed envelope.  This information will only be disclosed to those involved in the selection process.

REFEREES

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.

Name     _____________________________     Name     _____________________________

Address _____________________________     Address _____________________________

               _____________________________                    _____________________________

Postcode _____________________________    Postcode ____________________________

Tel No.   _____________________________    Tel No.    ____________________________

In what capacity does this referee know you? In what capacity does this referee know you?                              

DECLARATION

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.

Signed: ___________________________________        Date: ________________________

EQUAL OPPORTUNITIES MONITORING FORM

IN CONFIDENCE

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.

1.     Gender:  (please circle)          MALE                   FEMALE

2.     Age:        16-17     18-29     30-39     40-49     50-59     60-74     75+

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).

YES                    NO

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.

Asian British              Chinese

Bangladeshi               Indian

Black African              Mixed Race

Black British               Pakistani

Black Carribean        Other (please specify)

Black Other

White British

White Irish

White Other

Do you consider yourself to have a religious affiliation?     (Please circle).

YES                     NO

 If yes, how would you describe it?

EQUAL OPPORTUNITIES POLICY STATEMENT

Cruse Bereavement Care aims to offer to all throughout the United Kingdom a service which includes counselling, advice and opportunity for social contact.

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.

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.

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.

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.