HHAS Volunteer Application Form

Any information you provide will be kept confidential

Please tell us a little about yourself

 

Name*
Preferred Title
Address*
Town
 
Postcode
Daytime contact number
Evening contact number
Mobile number
Text / Minicom
FAX
e-mail address*
Year of birth

May we keep your details on computer? Yes No
Do you have a hearing loss? Yes No
Do you use a hearing aid? Yes No
Use of a car? (not essential) Yes No
Willing to use your car for voluntary work? Yes No
How far would you be willing to travel?

What is your current status? (eg waged or non-waged employment, retired, housewife etc)
When would you like to volunteer? Please state morning, afternoon or particular day of week

Which of our volunteer services interests you? Assistive equipment advisor
Hearing Aider Service
Resource Centre Volunteer
Clerical role at Resource Centre
Follow-up Equipment Volunteer
Volunteer Trainer

Just a little bit more about yourself, please
What other voluntary activities, if any, have you been, or are you currently involved in?
What are your life experiences and achievements, whether paid or voluntary?
Do you have any special skills, hobbies or languages you feel would be useful while volunteering?
What is your interest or motivation in volunteering with us?

References

Please give the names of two referees, not related to you, one of whom should be a professional person, such as a doctor, teacher, employer, religious leader, etc. The other can be a neighbour or personal friend. If your referees know you by another name, eg your maiden name, please let us know.
First referee
Second referee
Although we are a charity, we have a duty to protect the vulnerable people whom we help. Please give details of any criminal convictions, cautions or bindovers, if any, excluding minor motoring offences. Please provide details if applicable.
Please note, all applications will be subject to current Criminal Records Bureau (CRB) procedures.


Just a little bit more information and we shall be finished.


We want you to feel comfortable when discussing volunteering for HHAS. You may wish to indicate
your preferred location to meet. 		Volunteer Bureau
Woodside Centre
At home
Local Citizen's Advice Bureau

How did you hear about volunteering opportunities with Hertfordshire Hearing Advisory Service? Volunteer Bureau
Newspaper / Magazine
HHAS web site
Citizen's Advice Bureau
Word of mouth
HHAS leaflet
CVS office
Other

I confirm that the information given above is, to the best of my knowledge correct. I accept that any relevant information falsely given or withheld may prejudice my application or subsequent approval. Please check the box to agree. *

* Necessary fields for this form to be delivered.
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