Work experience form

Work Experience

1Personal Details

2Availability

3Application

4History

5References

6Declaration

Name(Required)

Title First Last

Address(Required)

Street Address Address Line 2 Town / City Post code

Primary phone number(Required)

Secondary phone number

Email address(Required)

Enter Email Confirm Email

Date of birth(Required)

DD slash MM slash YYYY

National Insurance no.(Required)

What days are you available to volunteer?

Day	Preferred start time	Preferred end time	Actions

There are no Days.

Maximum number of days reached.

Select days and times in 24 hour format.

When would you be available to commence your placement?(Required)

DD slash MM slash YYYY

Have you applied to Spectrum Active before?(Required)

Yes

When was this?

Please state why you are interested in a placement with us(Required)

What skills, experience and interests do you have that you feel would be relevant to this type of voluntary work(Required)

What do you hope to gain from volunteering with us?(Required)

Is there any other information or support needs that you feel we should know about at this stage?

Employment / Volunteering history

Name of provider	Date obtained	End date	Actions

There are no Employers.

Maximum number of employers reached.

Education and training

Type of training provider	Name of training provider	Name of course/ subject/ workshop	Start date	End date	Qualification achieved	Brief description of the outcome	Actions

There are no Providers.

Maximum number of providers reached.

Employer/ character referees

Name	Your relationship to this referee	Address	Phone number	Email address	How long have you known this person?	Actions

There are no Referees.

Maximum number of referees reached.

Please add at least two.

Declaration for the Rehabilitation of Offenders Act 1974

The Volunteer post for which you are applying is exempt, because of the nature of the work, from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974, by virtue of the Exceptions Order 1975 as amended. This means that all convictions, including those that are “spent” under the terms of the Rehabilitation of Offenders Act 1974, but excluding those that are “protected” under the Exceptions Order, will be made known to us. The information provided will be taken into account in deciding whether to make an appointment or not. It will be completely confidential and will be considered only in relation to this application. If your application is successful you will be required to co-operate with us in obtaining a Disclosure of criminal convictions from the Disclosure and Barring Service.

Do you have any convictions, cautions, reprimands or final warnings that would not be filtered in line with current guidance?

Yes

Please give full details.(Required)

Confirmation(Required)

I confirm that all the information entered is accurate to the best of my knowledge.

Work Experience

SAY HELLO!

SERVICE HOURS

REFERRALS

Work experience form

Work Experience

SAY HELLO!

SERVICE HOURS​

REFERRALS

SERVICE HOURS