volunteers-application-form powerlist foundation (updated dec 15)
DESCRIPTION
Why volunteer with the Powerlist Foundation?1) We are passionate and devoted to changing young people's lives by extending our high level leadership programme across the country. 2) We want to ensure that more young people are able to maximise their full leadership potential, irrespective of gender, race, school or family background. 3) We seek out young people from working class communities with both leadership potential and a desire to be tomorrow’s leaders. 4) We connect them with a network of influential decision-makers in order for them to lead change. 5) We arm young people with the self-awareness to be clear about their potential, their purpose and the contribution they want to make to our nation. 6) We nurture the next generation of leaders by coaching and advising students.TRANSCRIPT
Volunteer Application FormThis form can also be used if you wish to apply to be a mentor
Please return this form by email to [email protected]
How did you hear about the Powerlist Foundation?Powerlist Foundation website Word of mouthInternet Other (please state)
Personal details
Title: (please tick) Mr Mrs Miss Ms Other
First name: Surname:
Known as: Email address:
Address:
Postcode: Home tel:
Mobile: Work tel:
Company:
Job Title:
Brief description of your job role:
Is it okay for us to ring you at work? Yes No
Experiences
Have you been involved with voluntary organisations before? Yes No
If yes, please give details of your present or most recent volunteering roles:
Name of voluntary organisation:
From: To:
Brief description of your role:
Powerlist Foundation, registered charity in England and Wales (1138699) and a company limited by guarantee. Registered company in England and Wales (7082850). Registered office: Powerlist Foundation, c/o Powerful Media Ltd 2nd Floor, Cumbrian House, 217 Marsh Wall, London E14 9FJ Ref: PLF/PIDResponse15
Education background
Did you attend university? Yes No
Name of university:
Degree studied:
Do you speak any other languages? If yes, please give details:
REFERENCESPlease provide the contact details of two referees who are not relatives or partners. If possible one referee should have some knowledge of your previous paid work/volunteering.
Reference 1 Name: Job Title:
Address:
Postcode: Tel:
Email address: Relationship to you:
Reference 2 Name: Job Title:
Address:
Postcode: Tel:
Email Address: Relationship to you:
ADDITIONAL INFORMATIONPlease provide any additional information that might support your application, or might aid us in matching you to any other volunteering opportunities (if required)
REHABILITATION OF OFFENDERS ACT 1974Powerlist Foundation, registered charity in England and Wales (1138699) and a company limited by guarantee. Registered company in England and Wales (7082850). Registered office: Powerlist Foundation, c/o Powerful Media Ltd 2nd Floor, Cumbrian House, 217 Marsh Wall, London E14 9FJ Ref: PLF/PIDResponse15
What personal and professional experience and skills will you bring to volunteering with the Powerlist Foundation AVAILABILITY – Please tick availability, selecting preferred days/times.
Morning Afternoon EveningMondayTuesdayWednesdayThursdayFridaySaturdaySunday
Due to the type of work (involving contact with young people) you are required by the Rehabilitation of Offenders Act 1974 to declare all convictions including spent conviction. (Having a conviction will not necessarily prevent you from becoming a volunteer). You will also be subject to a check by the criminal Records Bureau.
Have you ever been convicted of a criminal offence: Yes No
If yes, please give details of conviction(s) and date(s)
Have you ever received a caution (except for driving offences) Yes No
If yes, please give details of caution(s) and date(s)
NEXT OF KIN
Give details of next of kinPlease give details of an emergency contact (if different from next of kin)
Name: Name:
Address:
Postcode:
Address:
Postcode:
Relationship: Relationship:
Contact details:
Home:Contact details:
Home:Work: Work:Mobile: Mobile:Email: Email:
DECLARATION
The information provided in this application will be used for the purpose of recruitment and the process of matching you with service users (if the role requires it). If successful, it will become part of confidential volunteer records. No personal information will be disclosed to parties external to Powerlist Foundation without your consent. Details of our data protection policy can be provided upon request.“I declare that, to the best of my knowledge and belief, the information provided on this form is correct”.
Name: Signature
Date:
Powerlist Foundation, registered charity in England and Wales (1138699) and a company limited by guarantee. Registered company in England and Wales (7082850). Registered office: Powerlist Foundation, c/o Powerful Media Ltd 2nd Floor, Cumbrian House, 217 Marsh Wall, London E14 9FJ Ref: PLF/PIDResponse15