PEER SUPPORT VOLUNTEER 
APPLICATION FORM

Thank you for your interest in becoming a Peer Support Volunteer at Auntie Pam’s.  Please complete this application form and return it to the address on page 4. 

Please complete in BLOCK CAPITALS
PERSONAL DETAILS	
Title:	Mr    Mrs    Miss    Ms    	
Forename:	     	Surname:	     	
	Are you over 18?	Yes / No	
Address:	     	
	     	Telephone numbers	
	     	Home :	     	
Postcode:		Mobile:		
Email address      	

EMPLOYMENT STATUS	
Are you: 		
Currently employed?	Yes    No 	
In higher education?	Yes    No 	
Retired from employment?	Yes    No 	

Please indicate when you are able to help	
Morning 	Afternoon 	Evening 	Full day 	

WHICH CENTRE WOULD YOU LIKE TO BE BASED AT?	
Huddersfield (New Street, Huddersfield) 
Tuesday, Wednesday or Thursday		
Dewsbury (9 Northgate, Dewsbury) 
Monday, Wednesday or Friday		

VOLUNTEERING INFORMATION	
Do you have any past or present voluntary experience?	Yes 	No 	
If yes, please give details:	

	
Why do you wish to undertake voluntary work within Auntie Pam’s?	

	

How did you hear about volunteering with Auntie Pam’s?	
Newspaper 	Poster 	Friend 	Website 	
Volunteer bureau 	Present volunteer 	Other 	

LANGUAGES	
First language spoken:	     	
Other language spoken:	     	

REFEREES	
Please indicate below the names and addresses of two referees, (NOT RELATIVES) who may be contacted:	
Referee 1:	
Title:	Mr    Mrs    Miss    Ms    		
Forename:	     	Telephone numbers	
Surname:	     	Home :	     	
Address:	     	Work :	     	
	     		
	     	Postcode:	     	
Are you known by any other name by this referee?   Yes    No 	
If yes, please type other name here:	

Referee 2:	
Title:	Mr    Mrs    Miss    Ms    Rev 		
Forename:	     	Telephone numbers	
Surname:	     	Home :	     	
Address:	     	Work :	     	
	     		
	     	Postcode:	     	
Are you known by any other name by this referee?   Yes    No 	
If yes, please type other name here:	     	

Race relations (Amendment) Act 2000

*	   I would describe my ethnic origin as:	

Asian or Asian British
 Bangladeshi                        
 Indian
 Pakistani
 Any other Asian background

Black or Black British
 African
 Caribbean
 Any other Black background
	
Mixed
 White & Asian
 White & Black African
 White & Black Caribbean
 Any other mixed background

White
 British 
 Irish
 Any other White background
	
Other Ethnic Group
 Chinese
 Any other ethnic group

 I do not wish to disclose this

Equality Act (Sexual Orientation) Regulations 2007

*	  Please select the option which best describes your sexuality	
 Lesbian
 Gay
 Bisexual	
 Heterosexual
 I do not wish to disclose this

Equality Act 2006

*       Please indicate your religion or belief
	
 Atheism                            
 Buddhism                         
 Christianity                       
 Islam                                	 Jainism
 Sikhism
 Other	 Hinduism
 Judaism
 I do not wish to disclose this	

Disability Discrimination Act 2005

	* Do you consider yourself to have a disability?	 Yes                                              I do not wish to disclose this           
 No	

CONFIDENTIALITY 	
All volunteers are asked to sign an agreement to maintain confidentiality, with regard to any personal/medical details about residents/patients before commencing voluntary work.
	
Signature:
	Date:
	     

Please read the following information carefully and sign below as directed.

If whilst a volunteer you are police cautioned, given final warning or reprimanded or are subject to any police investigation you must inform the Auntie Pam’s Project Officer immediately.

DATA PROTECTION ACT

As you have provided personal information to Kirklees Council on your application for voluntary service at Auntie Pam’s, this form seeks your consent for us to use the information provided.  General Data Protection Regulations sets out certain requirements for the protection of your personal information against unauthorised use or disclosure.  The Act also gives you certain rights.

I am happy to give the personal details required for processing this form. I understand that they will be stored until the end of the recruitment process. At which point they will be destroyed immediately, unless my application is successful. In which case they will be stored for 2 years from the date I leave the volunteering role.

I understand that they will be used during the recruitment process, will form the basis for your personal volunteer record and will not be shared with anybody other than Kirklees Council. I understand that I can withdraw or update my details at any time. For more information about how we store your data and how you can request your right to withdraw consent to use your personal data later please see http://www.kirklees.gov.uk/beta/information-and-data/how-we-use-your-data.aspx 

Please Return to:
FREEPOST RTAY-XJZK-STGL
Lisa Akester
Auntie Pam’s
9 Northgate
Dewsbury
WF13 1DS
Mark the envelope – Private and Confidential

Or email to lisa.akester@kirklees.gov.uk 

Signature: __________________________________

Full Name (printed): ___________________________

Date: ______________________________________

Thank you for completing this form!  
Privacy Notice for Volunteers 

What is the purpose of this document? 

Auntie Pam’s service collects and processes personal information about you during and after your volunteer relationship with us in order to manage that relationship. We are committed to being transparent about how we collect and use your data to meet our obligations under the General Data Protection Regulation (GDPR). 

What personal information^ do we collect and how is it used? 

Data we collect 	What we use it for 	
Names, addresses, telephone numbers, email addresses 	To contact you to discuss your volunteering role or to keep you updated on services or activities and events relating to your volunteer role.
	
Application form 	To build a picture of your skills, experience and interests in order to assess your suitability for volunteering at Auntie Pam’s.
 	
References 	To assess your suitability for volunteering with Auntie Pam’s.
	
Emergency Contact information	These nominated persons will only be contacted for emergency purposes in the immediate health or safety interests of volunteers.
	
Information related to availability and the reasons for periods of unavailability 	To assess your suitability for volunteering with us.

Some of the above grounds for processing will overlap and there may be several grounds which justify our use of your personal information. 

If you fail to provide certain information when requested, we may not be able to offer you a volunteering opportunity within Auntie Pam’s as we may be prevented from meeting our legal obligations (such as to ensure your health and safety and the health and safety of clients that access the Auntie Pam’s service). 

We will only use your personal information for the purposes for which we collected it, unless we reasonably consider that we need to use it for another reason, and that reason is compatible with the original purpose. If we need to use your data for an unrelated purpose, we will notify you and we will explain the legal basis which allows us to do so. 

Who has access to your data? 
Your information may be shared internally, including with staff members responsible for paying expenses, health and safety, insurances, events and marketing activities. Your consent will be sought before your data is shared internally.

How is your personal information collected? 
We collect information through our volunteer recruitment process, either directly from you or the references you will be asked to provide. We may collect personal information in the course of volunteering activities throughout the period of your volunteering for Auntie Pam’s, (e.g. training/qualification applications, supervisory meetings, etc.). 

Data Security 
Auntie Pam’s takes the security of your data seriously. We have internal policies and controls in place to ensure that your data is not lost, accidentally destroyed, misused or disclosed, or subject to unauthorised access. Where necessary, we implement appropriate network access controls, user permissions and encryption to protect data. 

Data Retention 
We will only retain your personal information for as long as necessary to fulfil the purposes we collected it for, including the purposes of satisfying any legal, accounting or reporting requirements.  Personal information will be stored until the end of the recruitment process. At which point it will be destroyed immediately, unless your application is successful.  If your application for volunteering is successful, personal information will be securely destroyed 2 years after the date you leave the volunteering role at Auntie Pam’s.

Your legal rights 
As a data subject, you have a number of rights, details of which can be found at https://ico.org.uk/for-organisations/guide-to-the-general-data-protection-regulation-gdpr/individual-rights/  If you have provided your consent to the collection, processing and transfer of your personal information for a specific purpose, you have the right to withdraw your consent at any time. Once confirmed, we will no longer process your information for the purpose you originally agreed to, unless we have another legitimate basis for doing so in law.
For more information about how we store your data and how you can request your right to withdraw consent to use your personal data later please see http://www.kirklees.gov.uk/beta/information-and-data/how-we-use-your-data.aspx 

Changes to this privacy notice 
We reserve the right to update this privacy notice at any time, and we will provide you with a new privacy notice when we make substantial updates. We may also notify you in other ways from time to time about the processing of your personal information.

^Personal information means any information about an individual from which that person can be identified. It does not include data where the identity has been removed (anonymous data).