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Thank you for applying to be a volunteer with Healthwatch North Lincolnshire.

We ask that you fill in this application form so that we can learn about the skills and experiences you have to help us in our work and also find out more about you and what you would like to get out of volunteering for Healthwatch North Lincolnshire. 
If you have any problems filling in any part of the form or have any queries about volunteering with us, please contact us on 01724 844986 or email enquiries@healthwatchnorthlincolnshire.co.uk and we will be happy to help.  
Once submitted, we will contact you to arrange an informal chat to discuss volunteering with us and what happens next.


All information provided in the application form will be treated as confidential and used only for the purposes of selection to be a volunteer and will be seen by those directly involved in the volunteer recruitment process.
Please note: If you are under 18 then the parent and guardian consent form will need to be completed.  
Thank you again for applying to volunteer with Healthwatch North Lincolnshire. 

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* 1. Please complete the following

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* 2. Are there any specific areas of volunteering you are interested in? please tick all that apply.

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* 3. Please let us know if you need support, adaptations, equipment or anything you feel we need to be aware of to enable you to volunteer with us, including communication needs.

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* 4. What interests you about volunteering with Healthwatch?

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* 5. What would you like to get out of volunteering?

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* 6. Please write down any information that you feel would be relevant to your application. This could include details of:

- Previous voluntary work undertaken

- Details of any skills you feel you are able to bring to Healthwatch

- Relevant work experience

- Personal qualities

- Qualifications or courses that you feel would be relevant.

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* 7. Please let us know your availability to volunteer for us. This information can be changed/ updated at any time.

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Monday
Tuesday
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Sunday

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* 8. Please declare any other roles which may be a potential conflict of interest and which may cause problems for you. (for example if you are a local Councillor).

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* 9. Have you ever been convicted of a criminal offence? (declaration subject to the Rehabilitation of Offenders Act 1974)

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* 10. In support of your application, we will need to contact two people who would be able to provide a reference for you. Are you happy to do this ? (if yes we will collect reference details at a later date)

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* 11. Declaration
The information in this application is true and accurate. I understand that any failure to declare relevant information or to provide false information could result in my application being rejected and my volunteer role being withdrawn.

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* 12. If appointed, I agree to abide by the requirements for good volunteer conduct; follow relevant Healthwatch policies; and act in the best interests of Healthwatch North Lincolnshire. I understand that if I am accepted as a volunteer this will be subject to receipt of two satisfactory references and if required for the role, a satisfactory Disclosure and Barring Service (DBS) check.

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* 13. I understand and agree that, as part of volunteering for Healthwatch North Lincolnshire, my details will be held in a confidential database that will only be used for reasons relating to my volunteering and this form will be filed in my confidential personnel file. All information about me will be held in accordance with the Data Protection Act 2018 and GDPR..

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* 14. How would you like us to contact you ?

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* 15. How did you hear about volunteering with us?

Thank you for taking time to complete this application.
We will contact you shortly to discuss the next steps to volunteering with us. 
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