Fillable Pdf 1410960308 Community Volunteer Application Form

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Pdf 1410960308 Community Volunteer Application Form

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Country of origin: UK
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Essex Fire Volunteer Application Form
Need help with your application?
Please email volunteers@essex-fire.gov.uk with contact details and one of our team will contact you.
Volunteer Role Applied For:
Do you need permission to work in the UK? Yes No
How did you find out about this volunteer role? A friend Internet
Media Other: _______________
Any personal data entered on this form may be held on computer files.
Personal details
Title (Mr/Mrs/Ms/Miss etc):
Surname:
Forename:
National Insurance No:
Address:
Home Email Address
Home Tel No: Mobile Tel No:
Current or most recent employment/voluntary work
Employer/Voluntary Organisation
name and address (if applicable):
Nature of Business:
Date Started:
Date Left:
Job Title:
Details of Main Duties and Responsibilities:
Previous Employment (including voluntary/unpaid work or work at home)
P
lease list the most recent first and continue on a separate sheet if necessary.
Employer
Employment Dates
Job Title
Reason for Leaving
From
To
Breaks in Employment History
If you have had any breaks in employment since leaving school, give details of these periods and your activities during
this time e.g. unemployment, raising a family, voluntary work, training etc.
Membership of Professional or Similar Bodies
(Please give details of any professional qualifications obtained)
Secondary School Education
School
To
Qualification
Grade
Dates
Continuing Education
(University/College/Apprenticeships etc.) Please list most recent first.
Educational
Establishments
To
Qualification
Level/Grade
Dates
Abilities, Skills, Knowledge and Experience
Why are you interested in volunteering with ECFRS?
Please provide any experience you have of working or volunteering in the community.
Please list up to 5 skills, knowledge or abilities you would like to bring to our organisation.
Do you speak another language:
If yes, please give details:
References
Please provide two referees, one of whom should be your current or most recent employer and the other a character
reference. If you have not been employed previously, please provide 2 character referees, preferably at least one of
whom should be from your school or college.
Notes:
(i) Please note that by providing such referees, you will be deemed to have given your consent for the Service
to apply for a reference.
(ii) If you were known by another name please give details
________________________________________________________________________
________________________________________________________________________
Ref 1 Name: Ref 2 Name:
___________________________________ __________________________________
Occupation: Occupation:
___________________________________ __________________________________
Address: Address:
___________________________________ __________________________________
___________________________________ __________________________________
___________________________________ __________________________________
T
elephone number: Telephone number:
___________________________________ __________________________________
E
mail address: Email address:
___________________________________ __________________________________
Driving
Do yo
u have a car that you would be prepared to use for your voluntary activities? YES / NO
If
YES please complete the following:
Do you have a full, current and valid driving licence for the classification YES / NO
of vehicle that you will be driving on ECFRS business?
If
YES, please state the type of licence:
If you are successful, you will be required to provide evidence of your licence prior to commencement of your
volunteer role.
Ins
urance
Please note that volunteers are responsible for arranging correct insurance cover for the duties you will be carrying out
on behalf of ECFRS and it is the responsibility of the volunteer to inform their own insurance company if they will be
carrying out volunteering activities which will include driving too and from appointments and events.
Wi
thout the correct cover you may not be able to claim in the event of an accident and you could also be prosecuted
for driving without the correct insurance cover.
MOT
and Road Tax
It
is your responsibility to ensure that your vehicle has a current MOT certificate and is licenced.
Do
cument checks
Re
gular checks will be made by the authority, or a third party company on its behalf, via the DVLA. You will not be
permitted to drive on ECFRS business until we have received confirmation that you have a valid licence, insurance
certificate (including business cover, if appropriate) and MOT certificate.
Additional Information
Hav
e you applied for or held a job with Essex County Fire and Rescue Service Yes No
or any other Fire Service before? If so, give brief details and reason for leaving.
Ar
e you related to any Essex Fire Authority elected member or any employee of Yes No
Essex County Fire and Rescue Service? If yes, please state the name of the
person and the relationship:
No
tes (i) Canvassing of elected members or employees of Essex County Fire and Rescue Service by, or on behalf
of, a volunteer applicant, whether directly or indirectly, is forbidden.
(ii) Failure to disclose a family relationship to any elected member or employee may disqualify the
volunteer applicant.
Yes / No
Yes / No
ECF
RS Volunteers will be required to attend training sessions, undertake volunteering events and attend supervision
meetings. Please indicate below your approximate volunteering availability per month:
5–10
hours 10–15 hours 16-20 hours 20-25 hours 25+ hours
What
hours are you able to provide?
A coupl
e of hours at a time Morning Weekdays
Half a day at a time Afternoon Weekends
Full Day Evenings Both
Do
you have any preference about the location of your volunteering? (Please state) YES / NO
Volu
nteer Emergency Contact Details
Any pe
rsonal data entered on this form may be held on computer files.
Tit
le (Mr/Mrs/Ms/Miss etc):
Surname:
Forename:
Relationship to Volunteer
Address:
Postcode:
Day Telephone No:
Evening Telephone No:
Mobile Telephone No:
I c
ertify that, to the best of my belief, the information I have entered on this community volunteer application form is
factually correct and I understand that any false information may result in termination of any volunteering
arrangement with Essex County Fire & Rescue Service.
Full Name:
Signed:
Date:
Ple
ase tick the box if you are filling in this form electronically to show that you have read the declaration above.
Availability
Yes / No
ESSEX FIRE VOLUNTEER APPLICATION FORM
1BPART 2
2BDISCLOSURE OF CRIMINAL CONVICTIONS
I
t is our policy to require all volunteer applicants to disclose any unspent criminal convictions.
T
he Rehabilitation of Offenders Act 1974 provides that certain convictions shall be regarded as "spent" after specified
periods of time have elapsed and you do not need to disclose convictions which are "spent" at the date you sign the
application form. Details of relevant convictions and time periods are as follows:
0
NOTES
(i)
A sentence of more than 30 months imprisonment or youth custody can never become
spent.
(ii)
If you were under 17 years of age on the date of conviction for any of the sentences
except those under the heading "For detention by direction of the Home Secretary",
please halve the period shown in the right hand column.
(iii)
It is immaterial for the purposes of calculating a "spent" conviction whether a sentence
is suspended or not.
T
he information you provide will be treated as strictly confidential and will be considered only in relation to the
volunteer role for which you are applying.
3BSentence 4BBecomes Spent After
For a sentence of imprisonment or youth custody exceeding
6 months but not exceeding 30 months
10 years
For a sentence of imprisonment or youth custody not exceeding
6 months
7 years
For a sentence of borstal training
7 years
For a fine or other sentence not otherwise covered in this table
5 years
For an absolute discharge
6 months
For a probation order, conditional discharge or bind over; and
for fit person orders, supervision orders or care orders under the
Children and Young Persons Acts (and their equivalents in
Scotland)
1 year, or until the order expires (whichever is
the longer)
For cashiering, discharge with ignominy or dismissal with
disgrace from Armed forces
10 years
For simple dismissal from the Armed Forces
7 years
For detention by direction of the Home Secretary:-
For a period exceeding 6 months, but not exceeding 30 months
5 years
For a period not exceeding 6 months
3 years
For a detention centre order
3 years
For a remand home order, an approved school order or an
attendance centre order
The period of the order plus a further year
after the order expires
For a hospital order under the mental Health Acts
The period of the order plus a further 2 years
after the order expires (with a minimum of 5
years from date of conviction)
Disclosure of a conviction does not necessarily mean that you will be unsuccessful in volunteering with ECFRS. We will
have regard to the ACAS Code of Guidance and a main consideration will be whether the offence is one which would
make a volunteer applicant unsuitable for the type of volunteer work to be done.
Will you please read carefully the above notes and then enter any convictions below. If no convictions, please enter
"NONE".
I
certify that, to the best of my belief, the information I have entered on this community volunteer application form
is factually correct and I understand that any false information may result in the termination of any volunteering
arrangement with Essex County Fire & Rescue Service.
F
ull name: ................................................................................................ Post No: ...............................................
S
igned ...................................................................................................... Date .....................................................
Please tick the box if you are filling in this form electronically to show that you have read the declaration above.
Offences, including
driving offences and Cautions
Date of Conviction Sentence
EQUALITY AND DIVERSITY MONITORING FORM
Essex County Fire and Rescue Service is committed to promoting equality and diversity and firmly opposes all forms of
unlawful and unfair discrimination, including on the grounds of race, religion, gender, gender reassignment, sexuality,
marital status, age or disability.
T
o monitor the effectiveness of our Equality and Diversity policy you are requested to complete this questionnaire and
return it with your Community Volunteer Application Form. The information provided will be used for monitoring
purposes only.
T
his section will be detached before shortlisting and held by the Human Resources Department
C
ONFIDENTIALITY
T
he provision of the information contained on this form is entirely voluntary and will in no way affect your community
volunteer application. It is collected to help the Service ensure that its volunteer recruitment arrangements are fair
and to monitor the effectiveness of our Equality and Diversity policy. The information that you provide will be treated
in the utmost confidence and will only be used for statistical purposes.
T
he information provided by the successful candidate will become part of their personal record as a volunteer with
Essex County Fire and Rescue Service. Information will be provided to authorised agencies such as the Office of
National Statistics, but only in the form of overall statistics and will not contain information that can be traced to
named individuals.
Volunteer Role Applied for:
Volunteer Role No. (if
applicable):
Full Name:
Date of Birth:
The categories below are in line with 2001 census.
1. Ethnic origin 6. Other ethnic group
I would describe my ethnic origin as: Other ethnic group
1. White Please specify ________________
British
Irish
Any other white background
Please specify _________________________ 2. Religious Belief
Christian
2. Black or Black British Buddhist
African
Hindu
Caribbean
Jewish
Any other black background
Muslim
Please specify _________________ Sikh
Other
3. Mixed Not stated
White and Asian
White and Black African
White and Black Caribbean
Any other Mixed background
3. Gender
Please specify _________________ Female
Male
4. Asian or Asian British
Bangladeshi
Indian
Pakistani
4. Sexual Orientation
Any other Asian background
Gay
Please specify _________________ Lesbian
Bisexual
5. Chinese Heterosexual
Chinese
5. Equality Act 2010
Before ticking the appropriate box please first read the definition of disability.
Definition of Disability
The definition of disability, as outlined in the Equality Act 2010 is as follows:
“A physical or mental impairment which has a substantial and long term adverse effect on a person’s ability to carry
out normal day-to-day activities”.
I do consider myself to have a disability as defined by the Equality Act 2010
(as detailed above).
I do not consider myself to have a disability as defined by the Equality Act 2010
(as detailed above).
I hereby give my consent for the Volunteer Recruitment Monitoring Information provided on this form to be held on
computer or other relevant filing systems and to be shared with other accredited organisations or agencies in
accordance with the Data Protection Act 1998.
Full name: ................................................................................................ Post No: ...............................................
Signed ...................................................................................................... Date .....................................................
Please tick the box if you are filling in this form electronically to show that you have read the declaration above.
✔
Please complete the following information to help us to fulfil our responsibilities under the Equality Act 2010 and
assist in the employment of people with disabilities.
Please describe any disability or condition which we may need to consider in assisting you to fulfil the duties of this
volunteering role:
Are there any arrangements we can make for you if you are invited for an interview?
Please specify, e.g. parking space, ground floor venue, etc.
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Completed 8 July 2020

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