Section 1 – Personal Contact Details

First Name

Last Name

Email

Telephone

Address (including Postcode)

Are you over 18 Are you over 18 Yes No

Additional information

Date Of Birth (DD/MM/YYYY)

School Name

Current School Year

Section 2 – Emergency Contact Details

First Name

Last Name

Email

Telephone

Address (including Postcode)

Relationship of contact

Volunteer Roles

Requested Role (Please indicate) Requested Role (Please indicate) Library Café Summer Reading Challenge Other

Please tell us why you would like to volunteer in the library and any relevant skills or experience you have.

Is there anything that may limit the tasks you are able to do, for example mobility problems, difficulty with lifting or carrying, inability to stand for long periods?

Section 3 – Availability

How much time do you have available to volunteer? Please give the number of hours/days per week:

Please indicate your preferred times for volunteering:

Weekday Weekday Tuesday AM Tuesday PM Wednesday AM Wednesday PM Thursday AM Thursday PM Friday AM Friday PM

Weekend Weekend Saturday AM Saturday PM

Preferred start date (DD/MM/YYYY)

Is this for Duke of Edinburgh work experience? Is this for Duke of Edinburgh work experience? Yes No

Participation dates

Date start

Date finish

Section 4 – Referees

Please give the name and address of two people whom we may contact for a reference (not family members), one should be a professional or work-related reference. Please note that we will contact these referees prior to the start of your volunteering. Some of our volunteering roles involve working with children, therefore we may seek information about any past disciplinary issues relating to children and/or child protection concerns you may have been subject to. If this is a work experience placement from a secondary school you only need to provide one reference from the school that you attend.

First referee

Name

Relationship

Telephone

Email

Second referee

Name

Relationship

Telephone

Email

Section 5 – Data Protection Statement

The information that you provide on this form and that obtained from other relevant sources will be used to process your application for employment. The personal information that you give us will also be used in a confidential manner to help us monitor our recruitment process.

Declaration Agreement – Blackfen Community Library are committed to the safeguarding of children and vulnerable adults. I understand that if I'm successful in applying, Blackfen Community Library will carry out a full DBS check Declaration Agreement – Blackfen Community Library are committed to the safeguarding of children and vulnerable adults. I understand that if I'm successful in applying, Blackfen Community Library will carry out a full DBS check I understand and agree to the terms

Dated (DD/MM/YYYY)