Title:*
Name:*
Faith (if none, please state):*
Nationality:*
Address:*
Tel Number Home:*
Tel Number Work:
Mobile Number:
E-mail:
Are you aged over the age of 18?:*
Are you available to volunteer all year round?:*
Are you willing to commit to all ongoing training sessions (approx six sessions per year on weekday evenings 17:30 - 21:00)?:*
Are you eligible to volunteer in the UK? (please check the status of your VISA if you are not within the European Economic Area EEA):*
Emergency Contact name & telephone number:*
Relevant Qualifications and Training:*
Occupation:*
Employment Status:*
Do you own a car?:*
Do you have a driving licence?:*
Do you currently work in prisons (paid or unpaid):
Please indicate how many hours per week you could volunteer for per week:*
Please provide any additional requirements that we may need to be aware of should you be invited to interview?:
Please indicate your availability to volunteer for Futures Unlocked:*

References

Please give the names of two people whom we will approach for a reference:
One should be a character reference from someone you have known for over 12 months (but not a family member) and one should be from a current or previous employer.  If self-employed please provide a second character referee.  PLEASE INFORM YOUR REFEREES THAT WE WILL BE CONTACTING THEM.

Character Referee

Character Referee Name:*
How do they know you?*
Character Referee Address:*
Character Referee E-mail:*
Character Referee Phone:*
-

Employer Referee

Employer Name:*
Employer Company Name:*
Employer Address:*
Employer Phone:*
-
Employer E-mail:*

Declarations

Disclosure of criminal records, Orders of Civil Courts, on probation, charged with an offence pending and other conduct. If you answer YES to any of the questions below, please give full details in the text box below.
Have you ever been convicted of a criminal offence (including any spent convictions under the Rehabilitation of Offenders Act, 1974), or been cautioned by the Police or bound over to keep the peace?:*
Have you ever been held liable by a Court for a civil wrong or had an order made against you by a matrimonial or family court?:*
Has your conduct ever caused or been likely to cause harm** to a child* or put a child* at risk, or, to your knowledge, has it ever been alleged that your conduct has resulted in any of those things?:*
*'child' for this purpose means anyone under the age of 18, **'harm' includes ill-treatment of any kind (including sexual abuse) or impairment of physical or mental health or development. This question relates to any conduct, whether as a paid employee, a voluntary worker, acting in a parental capacity or otherwise.
Please provide full details if answering YES to any of the above declarations:

Supporting Information

How did you find out about Futures Unlocked?:*
Why do you want to volunteer to support offenders?:*
What relevant qualities, skills and/or experience do you have?:*
Please tell us in less than 50 words why you would make a good mentor:*
By submitting this form, you confirm that the information you have supplied is correct, to the best of your knowledge and belief.

MONITORING INFORMATION
Futures Unlocked operates an equal opportunities policy, to help us monitor the implementation of this policy we would be grateful if you could complete the information below. Please be aware that this section of the application form is optional.
Gender:*
Do you consider yourself to have a disability?:*
If yes, please give details:
Cultural / Ethnic Origin*
Your Age:*