Volunteer Application Form - Victim Support IOM

Section 1: Personal Details

Title *

Forename *

Surname *

Previous Name

Home Address

Post Code

Previous Address (In the last 5 years)

Email Address *

Home Phone/Mobile *

Place and Date of Birth

Current Occupation

Section 2: Interests – This section aims to find out about your personal interests

What relevant skills do you have and how have you used them?

We would like to know about the influences on your life. Please describe below the difference this makes in your life

Please list the languages that you speak and indicate the fluency in each

Section 3: General information and disclosure (please circle appropriate response)

Disclosures made in this section help us give practical support to you concerning any involvement you may have with volunteering.

Do you hold a current full UK/Manx driving license

Yes

Please give details of any endorsements:

Do you have any disability or medical condition for which you receive treatment?

Yes

If yes, please give details

Do you presently suffer/have previously suffered from any mental illness for which you are receiving/have received treatment?

Yes

If yes, please give details

Is there anything that precludes you from working with children or vulnerable adults?

Yes

If yes, please give details:

Victim Support is able to require prospective volunteer visitors to disclose all convictions including ‘spent’ convictions, as this work is covered by the exemption order of the capital Rehabilitation of Offenders Act 2001

If you have any cautions/convictions, please tick this box

STATEMENT

I apply to become a (tick all that apply)

VSIOM Witness Service Volunteer

VSIOM Fundraising Volunteer

VSIOM Administration Volunteer

I agree to my details being passed to the police to conduct a check for convictions, and for the result of this check to be disclosed to Victim Support in confidence.

Signed

Date

Please return this for with an up-to-date CV to

If you are human, leave this field blank.