Volunteer Application Form

If you would like to become a volunteer at Headway Cardiff & South East Wales please fill out the form below with as much information as possible. Our Volunteer Coordinator, Kathryn Jones, will be in touch as soon as possible and you may be invited to an informal interview.

    Personal Details

    Title Forename Surname Date of Birth Address Email Phone Number

    Emergency Contact Details

    Title Forename Surname Address Email Phone Number Relationship to you

    When are you able to volunteer?

    Independence and Wellbeing Centre

    Mon 9:00 - 14:00Tues 9:45 -13:30Tues 13:30 - 14:00Wed 10:45 - 15:00Thurs 12:15 - 17:00Fri 9:45 - 13:30Fri 13:30 - 16:00

    Social and Activity Groups

    Tuesday Activity Group 10:30 - 13:00Thursday Social Group 13:45 - 16:00

    What is your current or previous occupation?

    Why would you like to volunteer with Headway Cardiff & South East Wales

    Please tell us about any relevant experience you have

    What would you like to gain from your volunteering experience?

    What are your interests and hobbies?

    Are there any jobs that for physical or personal reasons you are unable to do?

    How did you hear about volunteering with Headway Cardiff & South East Wales?

    Referee 1

    Title Forename Surname Address Email Phone Number Relationship to you

    Referee 2

    Title Forename Surname Address Email Phone Number Relationship to you

    Disclosure and Barring Service (DBS)

    The DBS was established under the Protection of Freedoms Act 2012 and merges the functions previously carried out by the Criminal Records Bureau (CRB) and Independent Safeguarding Authority (ISA). For appropriate volunteering roles it is Headway Cardiff’s policy to obtain checks form the Disclosure and barring Service. This process is initiated only once a potential volunteer has been given a provisional offer. Any information given will be held in the strictest confidence and only used in consideration of your suitability for the volunteering role and will not necessarily prevent you from volunteering.

    Have been convicted of any criminal offence?


    If yes please give details

    The exemptions to the Rehabilitation of Offenders Act 1974 require that applicants must declare all spent of unspent convictions for roles that involve working with vulnerable clients.

    Data Consent

    The data that you provided on your application form is collected so that we have accurate information on who is volunteering for our organisation and so that we are able to contact you with necessary information relating to your volunteering role. We need to confirm that we have your consent to contact you whilst you are volunteering for us and would like to know how we can contact you. Headway Cardiff & South East Wales will use your data for the following: - To run Disclosure & Barring Service (DBS) checks on volunteer applicants & current volunteers - To obtain references for applicants - To protect the health & safety of volunteers, service users & staff - To contact volunteers with updates and information relevant to their role - To provide Cardiff & Vale UHB with accurate records of those who volunteer on their hospital site for the health and safety of its staff, patients and visitors - To provide to the relevant volunteer bureau (GAVO, GVS, Interlink RCT, WCVA or C3SC) information for award and recognition purposes. - To provide references to other organisations upon request from volunteers (i) We will not share information about your DBS check or hold on file any personal documents related to the check. Once the check has been processed, all records of personal documents provided will be destroyed and we will only retain your certificate number and expiry date. (ii) No sensitive information will be shared with the Cardiff & Vale UHB or the volunteer bureau, only your name and contact details will be supplied to them. (iii) We will only share information with your volunteer bureau if you have signed up to their recognition programme (Millennium Star/Millennium Volunteer). Headway Cardiff & South East Wales will store volunteer’s personal information securely on a CRM system and will only be accessible to authorised staff. You have a right to access the information that we hold on you and you can make a request to see this information at any time by emailing or writing to us. Volunteer’s personal information will be kept for three year’s following the date they leave the organisation unless a reasonable request is made to destroy information at an earlier date.

    Please contact me with information about by role via

    EmailTelephoneText MessagePost We would also like to contact you about other areas of the organisation and we need your consent to be able to do this. If you do not wish to be contacted for any other purpose than that which relates to your role, please leave the following boxes blank. Please be assured that this will have no detrimental effect on your role and you may change your preferences and withdraw consent at any time by contacting us on 02920 577707 or emailing volunteers@headwaycardiff.org.uk.

    I would like to receive the quarterly newsletter by


    You can contact me about fundraising, events and donations by

    EmailTelephoneText MessagePost

    I consent to be filmed and photographed and for Headway Cardiff & South East Wales to use this media for publicity and information

    YesNo Please tick below to confirm you have read, understood and agree to the information above.Also, that the information provided on this form is accurate to the best of your knowledge. You understand that any information submitted in connection with volunteering and subsequently found to be incorrect may result in the termination of my volunteering with Headway Cardiff:

    I agree