st davids hospice care application form

Volunteer Application form

Personal Details

Areas Of Interest

Relevant Experience

Please summarise any experience (either paid work, voluntary work or other experience), Skills or qualifications which you consider to be relevant to the volunteering opportunity in which you are interested.


What days and hours are you available?



How would you travel to the place of volunteering?

Driving Licence

If you wish to volunteer as a driver, please complete this section:
(NB we will need to see your driving licence, insurance policy and MOT Certificate, if applicable)

Do you have a valid UK driving licence?


Do you consider yourself to have a disability or support needs that are relevant to your application?

Emergency Contact Details

Please supply the name and contact details of at least one person we may telephone in the case of illness or emergency.

Contact 1

Contact 2

Cautions, Rehabilitation and Criminal Records

Rehabilitation of Offenders Act 1974, (Exemptions) Order 1975

For certain volunteering roles which involve contact with vulnerable people, including children or patients of St. David’s Hospice Care, you are not entitled to withhold information about convictions which are for other purposes 'spent' under the provisions of the Act. Successful applicants will be required to complete a Disclosure Application at Enhanced level for submission to the Criminal Records Bureau. St. David's Hospice Care complies fully with the CRB Code of Practice and the Data Protection Act 1998 regarding disclosure information. Any information given will be treated as completely confidential and will only be considered in terms of its relevance to an application for positions to which the order applies. A criminal record will not necessarily be a bar to obtaining a position. If you have any concerns or queries on this matter, please seek advice from the Personnel Manager.


Please give below the names of two referees who have agreed to give a reference on your behalf. They should be a recent employer and/or a professional person, e.g. a school teacher, solicitor or councillor.

NB: Please note that two satisfactory references must have been received.

Business Reference

(e.g employer, doctor, teacher, solicitor)

Personal Reference

(Note: We do not accept references from family members)

Background Information

Have you had a recent bereavement of a close family member or friend?

We advise a person who has had such a bereavement not to volunteer at St David’s Hospice Care until at least one year has elapsed. If, however, you feel able to volunteer and would like to discuss the possibility of doing so, please contact the Personnel Manager, who will be happy to discuss this with you.


Not readable? Change text.