Which volunteer role are you interested in? Community Listener Community Researcher Independent Member of an Adult Social Care Partnership Board Youthwatch volunteer Which Partnership Board are you interested in joining? Carers Learning Disability - includes autism Older peoples Physical disability Sensory impairment First name and surname What name do you prefer to be called? Date of birth if you are under 18 years Home address and postcode Your email address Telephone number Please tell us why you are interested in volunteering with us? When are you available to volunteer, e.g. evenings, day time, weekends, flexible? Can we help make volunteering more accessible for you? For example, documents in large print or provide a hearing loop. Are there any religious or cultural beliefs you need to adhere to/tell us about that we need to take account of? References Please give details of two referees who have known you for at least one year. A referee can be a previous employer, someone from an organisation you have volunteered with, or a friend. They could also be a social worker, probation officer, or anyone else who has worked with you and knows you. Family members cannot be referees. If you are under 18, this could be a teacher or a youth leader. Referee 1 Name Address and postcode How do you know them? Email address of Referee 1 Telephone number Referee 2 Name Address and postcode How do you know them? Email address of Referee 2 Telephone number Criminal convictions Criminal record checks We may ask you to apply for a disclosure and barring service (DBS) check for some volunteer roles. If you need a DBS for this role - it will be stated in the role description. For roles where a DBS is not required, volunteers will be asked to declare any unspent convictions as part of the application process. If you have been barred from working with children or adults with care and support needs or have a serious spent or unspent conviction, you will not be able to volunteer for Healthwatch Cambridgeshire or Healthwatch Peterborough. However, applications from individuals with minor and spent convictions are accepted and will be considered on a case by case basis. Declaration I consent to Healthwatch Cambridgeshire and Healthwatch Peterborough keeping and using information about me - provided by me or by third parties such as referees - relating to this application to become a volunteer. If you are aged 16 or 17 years, please ask you parent or guardian to complete the consent form below. This information will be used in line with our privacy statement. Consent I declare the information provided in this form is correct and I consent to my data being stored and used by Healthwatch in Cambridgeshire and Peterborough to process my application. Parental consent Parental consent — this must be completed by a parent or guardian if you are aged under 18 at the time of applying. First and last name of parent or guardian Relationship to young person Parent or guardian contact number Email address of parent or guardian Consent of guardian I consent for my young person to take part in volunteering activities for Healthwatch in Cambridgeshire and Peterborough. I consent to my details and those of my young person being kept and used to support their volunteering, in line with the privacy statement. About you Where do you live? Cambridge East Cambridgeshire South Cambridgeshire Fenland Huntingdonshire Peterborough I do not live in Cambridgeshire or Peterborough How old are you? 16 to 17 years 18 to 24 years 25 - 49 years 50 - 64 years 65 - 79 years 80+ years Prefer not to say What was your sex recorded at birth? Male Female Prefer not to say How would you describe your gender identity? Woman Man Non-binary Intersex Prefer to self-describe Prefer not to say How would you describe your sexuality? Asexual Bisexual Gay man Heterosexual or straight Lesbian / Gay woman Prefer to self-describe Prefer not to say How would you describe your ethnicity? Arab Asian or Asian British: Bangladeshi Asian / Asian British: Chinese Asian / Asian British: Indian Asian or Asian British: Pakistani Asian / Asian British: Any other Asian / Asian British background Black / Black British: African Black / Black British: Caribbean Black / Black British: Any other Black / Black British background Mixed / Multiple ethnic groups: Asian and White Mixed / Multiple ethnic groups: Black African and White Mixed / Multiple ethnic groups: Black Caribbean and White Mixed / Multiple ethnic groups: Any other Mixed / Multiple ethnic groups background White: British / English / Northern Irish / Scottish / Welsh White: Irish White: Gypsy, Traveller or Irish Traveller White: Roma White: Any other White background Any other ethnic group Prefer not to say Do you have a disability? Yes No Prefer not to say Do you have a long-term condition? Yes No Prefer not to say Do you provide unpaid care or support for a family member or friend? Yes No Prefer not to say Please tell us how you heard about Healthwatch Submit Leave this field blank
