Citizens Advice Colchester

Issue Date: [04/01/2016] Issue Number:

[01]

Contact:
Citizens Advice Colchester
Blackburn House, ground Floor
32 Crouch Street
COLCHESTER
CO3 3HH

Telephone: 01206 244 828(admin calls only)

FAX: 01206 244 827

Registered charity no: 1097252

Company Limited by Guarantee No: 4431673

APPLICATION TO BE A VOLUNTEER WORKER

1. Name:

Mr/Mrs/Ms other (please state)

2. Address:

Telephone: Mobile:

3. e.mail:

4. Are you interested in any particular type of work?

For example, information & advice work, administrative, reception

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Issue Date: [04/01/2016] Issue Number:

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5. Education & Training

Please list any education and / or training (including short courses that you have
undertaken (continue on separate sheet if required).

Dates Education / Courses/ Training Qualifications

6. References
Please give below the names and addresses of 2 referees who can comment on your
suitability for the post. If you have been employed, we would normally seek a reference
from your present or most recent employer.

First Referee Second Referee

Name: . Name:

Position Held: .. Position Held: ..

Address: .. Address: ..

... ...

... ...

Tel No .... Tel No ....

References will be taken up for applicants who are short-listed for interview. Please tick the box if
you do not wish us to take up references before interview

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Issue Date: [04/01/2016] Issue Number:

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7. Paid and / or Unpaid Work Experience

Please include your current / previous employment including job training schemes)
voluntary work, community activities, school placements, time caring for dependents etc.
Please put these in date order, starting with the most recent (Continue on separate sheet
if necessary).

Dates Name of Employer / Organisation Nature of work

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Issue Date: [04/01/2016] Issue Number:

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8. Supporting Information
In this section, we would like you to give specific information in support of your
application. Using the role profile as a guide, demonstrate how you have the necessary
skills and abilities (please continue on a separate sheet if necessary).

I declare that the information on this form is correct to the best of my knowledge.

Signature . Date

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Issue Date: [04/01/2016] Issue Number:

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9. Disability

Do you have a disability? Yes / No

If yes, are you registered disabled? Yes / No

If yes, please give a registration number

10. Screening of Staf

In accordance with Citizens Advice national policy, we may ask any person joining the bureau
to be screened by the Criminal Records Bureau. However, a criminal record will not
necessarily be a bar to your being able to take up the role.

Have you ever committed an offence under sections 25 and 26(1)(d) or (g) of the Immigration
Act 1971?
Yes / No

11. Data Protection Act 1998

As part of the recruitment procedure, we may collect and store sensitive information about
you. We are required by law to obtain your consent to such data being recorded. It is our
policy to store data relating to recruitment procedures for 12 months after the date on
which it is submitted, for internal auditing purposes. Any information of this nature will be
treated confidentially.

Sensitive personal data is defined as information relating to any of the following: racial or
ethnic origin, political opinions, religious beliefs, trade union membership, health, sexuality
or sex life, offences and/or convictions.

For the purposes of the Act, the Data Controller is the Colchester Citizens Advice Bureau.

12 What prompted you to apply?

Advert state where

Vacancy Bulletin

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Other - please specify

EQUAL OPPORTUNITIES MONITORING FORM

Confidential

Please return this with your application form. It will be separated from your
application before short-listing. The selection panel will not see this form, which will
be used for monitoring purposes only.

Post applied for ___________________________________________

Surname / family name __________________________________________

First name (s) __________________________________________

Gender Female / Male (please indicate) Age

Ethnic Group
Please indicate your ethnic group

White Mixed Asian or Asian Black or Black Chinese or

British British Other Ethnic
Group

British Black and White Indian Black Caribean Chinese

Caribbean
Irish Pakistani Black African Other Ethnic
Black and White Group
Other White African Bangladeshi Other Black

Black and White Other Asian

Asian

Other Mixed

Disability

Do you have a disability? Yes / No (please indicate)

Where did you hear about this vacancy? ___________________________

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Issue Date: [04/01/2016] Issue Number:

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________________________________________________________________

Thank you for completing this form.

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