Dementia Information Event

Please tick to confirm you meet all of the criteria if you wish to volunteer

I am over 16 years old I am able to commit to a minimum of 2 hours per week over a 6-month period I am willing to undertake a DBS disclosure

Please tick the volunteering opportunities that you are interested in

Please tick which location you would like to volunteer at:

The Outback Community Kitchen & Garden Hanson Lane Enterprise Centre Elsie Whiteley Innovation Centre

Please tick below to specify what days you could be available as a volunteer:

Please tick below to specify what time of day you could be available as a volunteer:

Morning Afternoon

Your details

Full Name

Address and Postcode

Home Tel:

Mob:

Languages Spoken

How did you hear about this volunteering role?

Please explain why you would like to be a volunteer with Halifax Opportunities Trust

Please provide details of any previous employment or work experience. This can be either paid or unpaid work.

Please give two independent referees who would be willing to supply a character reference (these must not be family members)

Reference 1 Name:

Reference 1 Address:

Reference 1 Tel:

Reference 1 Email:

How does Reference 1 know you?:

Reference 2 Name:

Reference 2 Address:

Reference 2 Tel:

Reference 2 Email:

How does Reference 2 know you?:

Other

Do you have any convictions, cautions, reprimands or final warnings that are not “protected” as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013) If yes, please give details on a separate sheet and enclose in a sealed envelope marked ‘Private and Confidential, for Interview Panel Only’ which you should attached to your completed application form.

Yes No

Are you related/close to a person closely associated with our organisation? (if so please give details) (A candidate who fails to disclose a relationship will be disqualified and, if appointed, will be liable to dismissal).

DISABILITY DISCRIMINATION ACT 1995

If you require any special arrangements to be made to assist you if called for interview, please let us know in advance of the interview.

DECLARATION

I declare that the information I have given on this form is true to the best of my knowledge. Failure to provide information requested or providing inaccurate information will disqualify you from volunteering at Halifax Opportunities Trust.

Confidential. Equal Opportunities Monitoring Form

Halifax Opportunities Trust is committed to recruiting, retaining and developing a workforce that reflects the diverse communities that we work with. It is vital that we monitor and analyse diversity information so that we can ensure that our HR processes are fair, transparent, promote equality of opportunity for all staff, and do not have an adverse impact on any particular group. Any information provided on this form will be treated as strictly confidential and will be used for statistical purposes only. No information will be published or used in any way which allows any individual to be identified.

1. Gender

Male Female

2. Are you married or in a civil partnership?

Yes No

4. What is your ethnicity?

b. Mixed/multiple ethnic groups

White and Black Caribbean White and Black African White and Asian Any other mixed background

c. Asian/Asian British

Indian Pakistani Bangladeshi Any other Asian background

d. Black/African/Caribbean/Black British

African Caribbean Any other Black/African/Caribbean background

e. Chines or other ethnic group

Chinese Any other ethnic group

f. Prefer not to say

Prefer not to say

5. Do you consider yourself to be disabled?

Yes No Prefer not to say

8. What is your current working pattern?

Full-time Part-time Prefer not to say

By completing this form you have helped us better understand how we, as an employer, ensure equality of opportunity for all.

Thank you for completing this form.

Data Capture

Halifax Opportunities Trust is registered with the Information Commissioners Office (ICO) under the provisions of the Data Protection Act 2018. Halifax Opportunities Trust takes its responsibilities under the Act very seriously. The information provided by you is collected for the purposes of processing your application for volunteering. Application forms are used to determine who to interview for the volunteer opportunities by way of shortlisting. If you are successful in your application and are subsequently offered a volunteering opportunity with Halifax Opportunities Trust, the data collected will be used to carry out pre-employment checks and ensure your suitability for the role. The data will then be transferred onto your personnel file. You may withdraw consent at any time to recruitment@regen.org.uk. In addition you have the right to see what information is held about you, to have inaccurate information corrected, to have information removed from our system unless we are required by law or a statutory purpose to keep it and the right to complain to the Data Protection Officer if you feel that the data has not been handled in accordance with the law. Halifax Opportunities Trust Data Protection officer, Malgorzata Ciewiertnia, can be contacted at Privacy@regen.org.uk Application forms will be kept for a period of six months for unsuccessful applicants. For successful applicants, the information will be transferred to your personnel file and will be kept for a maximum of your time spent volunteering with us plus seven years or as per recommended guidelines for roles working with children and vulnerable groups, term of volunteering placement plus 25 years or until such a time as the data is reviewed. To read HOT’s full Privacy Policy please visit the website at www.halifaxopportunitiestrust.org.uk/privacy-policy

Activity Information

Activity Description

How to Book