Volunteer Application Form

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Thank you for your interest in volunteering with Reconnections. Please complete our application form below. Please be aware that you can't save and return to your answers later but it shouldn't take you more than 10 minutes to complete.

Please choose your area:

We are currently not recruiting any new volunteers for Reconnections in Barking, Dagenham and Havering. Please visit https://www.independentage.org/get-involved/volunteering for other volunteering opportunities at Independent Age.

How Can I Help?

I am interested in.... (please tick as many as apply)

Being matched to an older person in my community so I can visit, accompany to activities, etc.Being matched to an older person in my community who is housebound and needing a visitorBeing matched to an older person in my community who needs regular telephone callsHelping from time to time at events or group activitiesOther – please let us know your ideas on how else you would like to get involved

Other

How Did I Find You?

We are interested to know how you heard about us

Social Media (e.g Facebook, Twitter)Word of Mouth (e.g. family, friends)Newspaper / MagazineInternet search / WebsiteTelevision / RadioLeaflet / PosterEventOther

Other

My Details

First Name

Last Name

Email Address

Contact Telephone Number

Date of Birth

What best describes your gender?

How do you self-describe?

Home Address

Name/Number & Street

City

Postcode

My Match

Please tick all boxes that apply so we can find out a bit more about you and to help the matching process.

Location and Transport (please tick as many that apply)

I am happy to volunteer in my local area (we will get this detail from your home address)I am happy to volunteer in a different location (please give details below)I have access to a car and have a valid driving licenceI don't have access to a car and will rely on walking / public transport / other

In case of emergency, please provide us with your own car make, colour and registration details:

Address of other location you'd be happy to volunteer in

Interests - Social Setting

Organised groupsInformal gatherings1-1 friendships

Interests - Sport and Health

Watching sportsPlaying sports / health and fitness

Interests - Outdoors

Outdoors/WalkingGardening/Allotment

Interests - Creative

Music/Dancing/SingingArts/Crafts/Knitting/PhotographyCarpentry/DIY

Interests - Culture

Cinema/Film/Theatre/ComedyReading/Books/WritingMuseums/Attractions

Interests - Faith

Faith groups

Interests - Food & Drink

Cooking/Baking/DietPubs/Cafes/Restaurants

Interests - Games

Snooker/Pool/DartsBoardgames/Cards/Puzzles/Quizzes

Interests - General

Animals/ PetsHistory/Current Affairs/PoliticsCars/Motorbikes/Trains Travel/GeographyHair/Beauty/FashionTechnology/Social Media/Skype

Do you speak any other languages?

Languages you speak

Use Shift + Click to select multiple languages.

Other languages spoken

Specialist interest areas, skills or experience:

Mental HealthDiabetesPhysical disability / Poor mobility / FrailtyAddictionCarer (e.g. looking after relatives or friends)Other

Other specialist interest areas - details:

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Volunteering Experience

Your volunteering experience (please select one option)

I have never volunteeredI have volunteered with a different age groupI have volunteered with older peopleI have volunteered with people of all ages

Availability

When will you typically be available to volunteer? (Don't worry if this changes)

Weekday MorningWeekday AfternoonWeekday EveningWeekend MorningWeekend AfternoonWeekend EveningOther

Please specify other availability

Additional Details

If there is anything else we should know about you, including if you have any additional needs you would like us to be aware of, please tell us below.

My Referees

Please give us the contact details for two referees who have been known to you for over 2 years and are not family members (you can give us this information later if you don't have it to hand now).

Are you able to provide us with the details of referees at this point in time?

YesNo

Referee

First Name

Last Name

Address

Email

Phone Number

How do you know them?

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Disclosure

Some of our volunteer roles are eligible for a Disclosure and Barring Service check. We consider each application on a case by case basis.

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)?

YesNo

Do you have an existing Enhanced Criminal Disclosure Check for Adults that is registered on the DBS Update Service? If you answer "No" that's fine, as we will apply for a DBS certificate on your behalf

YesNo

If you know your certificate number, please include below:

In Case of Emergency

Emergency Contact's Full Name

Relationship to you

Email Address

Telephone Number

Has this person agreed for us to hold their details as your emergency contact?

YesYou must provide us with emergency contact details from someone who has consented for you to do so.

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Volunteer Training

Training takes place online, using Zoom. It's an interactive 2 hour session. The next available training sessions are shown below. Please indicate your preferred date and time, or add details of your availability in the comment box. You will receive an email confirming your place shortly.

Preferred training session

Availability details if 'None of these'

Volunteering Impact

Finally, we are keen to understand the impact that taking part in volunteering has on people.

How would you rate your general feeling of wellbeing now? (how do you feel in yourself?) Note: 0 = As good as it could be; 6 = As bad as it could be

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How strongly do you feel you belong to your community? Note: 0 = As good as it could be; 6 = As bad as it could be

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