1 Start 2 Complete Your name * Preferred pronouns (she/he/they) Your address * Please provide your street address and postcode. Your date of birth Day12345678910111213141516171819202122232425262728293031 Day MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Year1931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Year Telephone number * Email address * Volunteer roles * Which role(s) are you interested in? (see role descriptions on the Volunteer page) Why would you like to volunteer with us? Do you have any experience that will help you volunteer with us? Where did you find out about our volunteering opportunities? * Reasonable adjustments Please let us know of any reasonable adjustments we could make to enable you to volunteer with us. Availability When would you like to volunteer with us? If you have preferred days, times or duration of volunteering please let us know here. This is not binding and can be altered if your situation changes. We can not guarantee to have opportunities available during these times but will try to accommodate your needs. Disclosure and Barring Service DBS * Yes No I am subscribed to the update service and am happy for you to run a check. Only certain volunteer roles and activities at Healthwatch North Yorkshire are eligible for checks other than a basic check, eligibility for standard and enhanced checks is prescribed in legislation. Please double-check the Volunteer Role Description to make sure that you are happy with the requirement of the role. Are you willing to undertake a DBS check? (Note - previous DBS certificates are not valid unless you subscribe to the update service) Declaration of convictions * Yes No Some of Healthwatch North Yorkshire volunteering opportunities may involve direct contact with potentially vulnerable members of the public. These roles are exempt from the Rehabilitation of Offenders Act 1974 (amended). This means that if you are applying for a role which will involve contact with vulnerable people you will be required to declare your entire criminal record including cautions, reprimands, final warnings and criminal convictions categorised as spent under the above legislation. This information will only be disclosed to specific Healthwatch North Yorkshire staff. Have you been convicted of a criminal offence (other than 'spent' convictions under the Rehabilitation of Offenders Act 1974 (amended))? Details of convictions If yes, please provide details: Data protection * I declare that the information in this application is correct to the best of my knowledge and acknowledge that by checking this box I give my consent to sensitive personal information being recorded and stored. As part of the recruitment procedure, we may collect and store sensitive personal data about you. It is our policy to store data relating to recruitment procedures for a minimum of 12 months agter the date on which it is sumitted. Any information of this nature will be treated confidentially. Sensitive personal data is defined as information relating to any of the following: radial or ethnic origin, political opinions, religeous beliefs, trade union membership, health, sexuality or sex life, offences and/or convictions. Will you fill out our Equal Opportunities form? Yes No Submit
