Remote Mentoring Volunteer Application

First Name *

Please give us your full legal first name - we will use it when we undertake the DBS/police check

Family Name *

Please give us your full legal family name - we will use it when we undertake the DBS/police check

Preferred name - is there another name you prefer to be known by? *

Your preferred name *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Telephone *

Email *

Date of Birth *//

I am under the age of 18.

Yes, I am under the age of 18.

Parent's Name *

First

Last

Parent's Mobile Telephone Number *

Parent's Email *

Parent's Signature *

Emergency Contact

Emergency Contact Name *

Relationship to you *

Contact Telephone *

References

Please give us the names and contact details of two people who know you well (for at least 6 months) and would be happy to answer a few questions about you. One should be an academic tutor or an employer, the other can be a personal contact (but they cannot be your partner or a family member). If you have only been in the UK for a short time, we can take up references from people based outside the UK

Reference 1 Name *

Reference 1 Email *

Reference 1 Telephone

How do you know this person? *

When did you last have contact with them? *

Reference 2 Name *

Reference 2 Email *

Reference 2 Telephone

How do you know this person? *

When did you last have contact with them? *

Which project are you interested in volunteering with? *

Holiday Club for teenagers
Holiday Club for 5 to 11 year olds
Educational Mentoring
Homework Club
Progress in work and education support
Interpreting
Other

In case we cannot take on more volunteers for this project, what other project would you be interested in? *

How would you like to support us? *

Availability

I confirm that I am available on Tuesdays, Wednesdays, or Thursdays during term time, from 3.20 to 5.50pm, for a minimum of one school term. *

My preferred day is *

Tuesday
Wednesday
Thursday

I confirm that I am available from 9am to 5pm for a minimum of one day (one session) during the school holidays. *

I confirm that I am available after school one day per week, during term time, for at least 6 months *

I am available for a minimum of 1 hour per month, over a minimum of 3 months. *

Please answer the following questions:

Why do you want to do this role and what do you think would make you good at it? *

What is your occupation? Are you currently employed, unemployed or a full-time/ part-time student? *

Please tell us about any post-secondary school qualifications that you have i.e. A-Levels, NVQ qualification, college or university qualifications *

Have you any personal or professional experience of working or volunteering with children or young people? If yes, please describe your experience. *

Have you any experience of working or volunteering with refugees, asylum seekers or migrants? If yes, please describe your experience. *

Please tell us about any special interests or hobbies that you have. *

Do you speak any languages other than English? If yes, please list them. *

How did you find out about Salusbury World and about this project? *

Support and Health Needs

Salusbury World welcomes volunteer applicants with a range of abilities for the skills they bring. We aim to create a positive environment that enables all volunteers to realise their full potential. In order that we can consider any appropriate adjustments to the volunteer environment and better support you in your role, please give details of any disabilities or health issues. *

Is there anything you need us to do or provide to enable you to volunteer with us? *

Equalities and Monitoring

Salusbury World recognises and values people’s differences and will assist them to use their talents to reach their full potential. We welcome volunteer applications regardless of age, sex, race, nationality, ethnic origin, religion, disability or sexual orientation. You do not have to complete this part of the form but if you would like to do so the information will be very helpful to us in understanding where we need to target volunteer recruitment. This is to help better support the refugees and migrants we work with.

What is your gender?

Female
Male
I describe my gender in another way
Prefer not to say

Ethnicity

White British
White Irish
Any other White background (please specify)

Mixed

White and Black Caribbean
White and Black African
White and Asian
Any other Mixed Background

Asian or Asian British

Indian
Bangladeshi
Pakistani
Sri Lankan Tamil
Sinhalese
Any other Asian background (please specify)

Black or Black British

Black Caribbean
Black Ghanaian
Black Nigerian
Black Somali
Any other Black background (please specify)

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Other Ethnic Groups

Chinese
Filipino
Kurdish
Arab
Any other background (please specify)

(copy) (copy)

File Upload *

Please attach your CV.

GDPR Agreement *

I consent to having this website store my submitted information so they can respond to my inquiry.

Mailing List

Keep me up to date with all the latest news and events from Salusbury World!

By ticking this box, I consent to Salusbury World adding me to the mailing list.

Keeping Children Safe

We are committed to protecting the children, young people and families we work with and keeping them safe. We select, check and manage our volunteers to make sure that we are able to do this. // Criminal Record and Disqualifications A criminal record is not necessarily a bar to volunteering with us but, due to the nature of the role, any criminal record will need to be disclosed to us. You must include all convictions you've ever had – even if they're now spent, or if you were a juvenile at the time. Please, therefore, answer the following questions:

Have you ever been convicted of any criminal offence or cautioned, reprimanded or given a final warning by the police (spent or unspent)? *

Are you disqualified from working with children or vulnerable/protected adults? *

Are you aware of any police enquiries, following an allegation made against you, which may have a bearing on your suitability for the role? *

If yes, please give all details of all offences, penalties and/or police enquiries to Sarah Reynolds, Director of Salusbury World. You can email Sarah at sarahreynolds@salusburyworld.org.uk or post or deliver a letter containing the information, to Salusbury World, Salusbury Primary School, Salusbury Road, London NW6 6RG. This information will be kept confidential. // DBS: You do not need a recent Disclosure and Barring Service Check (or even to know what one is) to volunteer with Salusbury World – we will sort this out for you, if one is needed. If, though, you do have a recent DBS and are registered with the Update Service, please let us know.

Data Protection Act: Adult Volunteer Consent

In order for Salusbury World projects to work efficiently we may need to record your details. These details may contain your personal and sensitive data. // What is personal and sensitive data? Personal data is data which can be used to identify you. This may include your name, date of birth, address, telephone number etc. Sensitive data is information related 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. // Where will you store my data? Your data will be stored in an electronic case management system accessed by members of staff at Salusbury World. Paper copies of your data may also be stored securely by Salusbury World. To comply with the Data Protection Act 2018 we must tell you how we use this data and ask for your permission. By signing this form you are providing your permission for us to process your data for the purposes below.

1) Permission to store your data: I/We give my/our consent to Salusbury World to record sensitive personal information about me/us. *

I/We consent.
I/We do not consent.

Name *

Signature *

2) Permission to share your data with relevant agencies and to receive data from relevant agencies. Everything you tell us will be treated confidentially. However for the safety and welfare of yourself and children in your care, we may need to share your data. I/We give my/our consent to Salusbury World to record sensitive personal information with other relevant agencies. *

I/We consent.

Name *

Signature *

What is a Data Controller? A Data Controller is someone who is responsible for your data and who must make sure that your data is processed according to the law. For example, they are responsible for making sure that the information held about you is accurate and that it is kept secure. // What does Data Controller in common mean? For the purpose of the Data Protection Act the members of the Salusbury World are Data Controllers in common. This means that the members of Salusbury World are responsible jointly for your data. // Can I withhold or revoke my consent? Yes we will not record your information unless you provide your consent. We will not share your information with anyone else without your consent unless required to do so by law. If you require us to delete your data, please notify us in writing and we will do so within 14 days // Data Access: request please notify us in writing and we will let you know all the data that we store on you within 14 days // Complaints handling procedure: Salusbury World has a complaints handling procedure. Full details of the complaints procedure are available on request.

Declaration

I confirm the following: -The information given on this form is correct and complete to the best of my knowledge. I understand that if this application leads to a volunteer placement, that false or misleading information given in this form or in my interview may result in the termination of the volunteering opportunity. -Salusbury World can contact the referees detailed on this form. -I am not banned or disqualified from working with children nor subject to any sanctions or conditions imposed by the Disclosure and Barring Service or any other regulatory body. -I understand that photographs and video/film material may be taken of me and I give my consent for such material to be used by Salusbury World, and organisations they work with, in newsletters and reports, on websites and on social media.

Signature *

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