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. We will be in touch as soon as possible and you may be invited to an informal interview.
Title ---MrMrsMissMsDrProfOther Forename Surname
Date of Birth
Phone Number (Mobile)
Phone Number (Landline)
Relationship to you
Mon 9:00 - 14:00Tues 9:45 -13:30Tues 13:30 - 14:00Wed 10:45 - 15:00Fri 9:45 - 13:30Fri 13:30 - 16:00
Tuesday Activity Group 10:30 - 12:00Wednesday Walking Group 10:30 - 12:30Thursday Social Group 13:15 - 14:45
I can speak WelshI can read WelshI can write in Welsh
I have a current driving licenseI own a carI would be prepared to use my car for business useI have insurance for business use
To assess your suitability for the role, we will take up references from individuals who have known you for at least two years and are aged 18 years or over. They must not be a family member nor live in the same household as yourself and they must be able to comment on your ability to perform the role that you are applying for.
Wherever possible, please supply us with an email address, as this is the quickest and most effective method of communication. If your referee would prefer us to contact them in another way, please tell us.
Relationship to you
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.
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.
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 email@example.com.
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: