Volunteer Application Form

Thank you for showing your interest in volunteering with us.

Please complete the below application form.

Our 3 step recruitment process is comprehensive but fair, and we want to encourage a broad range of volunteers as this will bring extra diversity and skills to our services. The minimum age is 16.

Complete the application form. Please note that some documents, such as ID, will need to be
uploaded electronically as part of your application.

We will then send you relevant information and some additional forms.
We may also require a Disclosure and Barring check. Please read the DBS Privacy policy.

If you do not have a five year UK address history, a Certificate of Good Conduct from your
country of origin or embassy will also be required.

Under 18’s will also be sent a form for Parent/Guardian authorisation.

Informal interview followed by a compulsory training session before your volunteering role
begins. (Due to Covid – 19 we are using technology such and Zoom and Facetime to operate
our interviews and training. We can discuss how this works best for you).

If you want to find out more about volunteering before you apply to Sussex Community NHS
Foundation Trust, please contact our Voluntary and Community Development team::

Brighton and Hove - 01273 242191

West Locality - 01273 696011 ext.8135

High Weald, Lewes and Havens - 01273 666498

Central Locality - 01293 301001

Please ensure that referees, emergency contacts & Health Visitors (if appropriate) have been informed that we will be holding their information.

All mandatory fields are highlighted with *

Title *

First name *

Surname *

Home address *

Town/city *

County *

Postcode *

Contact number *

Email address *

Please select (you can select more than one) your preferred method of contact. *

Email
Post
Telephone

Emergency Contact

Emergency contact name *

Emergency contact relationship *

Emergency contact number *

About You

Where would you like to volunteer?

Area

Central (Crawley - Horsham and Haywards Heath)
West (Arundel - Bognor - Rustington and Worthing)
Brighton and Hove - please note roles here are mainly administrative
HWLH (Lewes - Uckfield and Crowborough

If you would like any reasonable adjustments made, please let us know prior to the interview. Any adjustments made will not have any bearing on the outcome of the interview.

How did you hear about Voluntary Services at SCFT? *

Relevant skills/experience: In no more than 200 words, please tell us your reasons for wanting to volunteer with Sussex Community NHS Foundation Trust. *

Please record details of your current employer/college/career/life history for the past five years. *

Are there any adjustments that need to be taken into account for you to volunteer for this organisation? *

Yes No

Availability

We usually ask our volunteers to attend weekly. Most of our volunteer opportunities occur Monday - Friday during working hours, although some opportunities are available at weekends and early evenings. Please let us know your availability below.

References

Please provide details of two people from two different organisations to whom we may write for a reference. These should be recent contacts, one should be known to the applicant for at least two years and one should be a professional reference if possible. Family members are not acceptable referees. It is useful for one referee to be a previous or current employer. For applicants who have not recently been in employment there are a number of individuals who could act as referees. These include: religious or cultural leader, teacher or tutor, case worker, community or social worker, family doctor.

Reference one

Reference *

Address *

Town/city *

County *

Postcode *

Contact number *

Email address

Relationship *

Length of time known *

Reference two

Reference *

Address *

Town/city *

County *

Postcode *

Contact number *

Email address

Relationship *

Length of time known *

ID Badges

For your NHS Volunteer ID badge, please upload a clear headshot photograph.

If you are unable to upload your photo now within your application you will need to take and send up a colour photograph of head and shoulders for your Volunteer ID badge.

ID Badge photo

Residency

Are you a United Kingdom (UK) European Community (EC) or European Economic Area (EEA) National? *

Yes No

Please supply details of any Visa currently held below.

Visa number

Start date

Expiry date

Any restrictions

Please read the below statements

I confirm that the information that I have provided in this application form is correct and complete. I understand and accept that if I knowingly withhold information or provide false information this may lead to my application form being rejected.

Non-compliance with policies and procedural documents can affect patient safety, SCFT’s compliance with the Care Quality Commission (CQC) regulations, NHS Litigation Authority standards, and audits or inspections carried out by internal and external auditors and that a breach of Trust policies and procedures could be considered gross misconduct and may lead to dismissal and in some cases criminal prosecution.

I understand that during my voluntary work within the Trust, I may have access to information designated by the Trust as being of a confidential nature. I must not divulge, publish or disclose such information without prior written consent of the Trust. Improper use or disclosure of confidential information will be regarded as a serious disciplinary matter under the provisions of Data Protection Laws and must be reported.

I confirm that I have read the Volunteer Privacy Policy and DBS Privacy Policy.

I undertake to conduct myself in a responsible manner whilst volunteering for SCFT, to endeavour at all times to serve the patients and to work to foster good volunteer/staff relationships. I have read and understood the Volunteer Agreement and Privacy Notice.

I confirm and understand the above statements and agree to the Volunteer Privacy Notice.*

I can confirm I have read and agreed the DBS Privacy Policy .*

As an NHS Trust, we keep information about you for administrative purposes and this information is held confidentially and securely. The handling and processing of personal information is strictly controlled by Data Protection Laws.

Uniform

As part of your volunteering role you maybe required to wear SCFT uniform, either a Polo Shirt, Tabard or High Visibility Vest. Please select the size that you think is most appropriate for you.

Proof of identity

To speed up the process of your application it would help us greatly if you could upload copies of your proof of identity to this application. We need to see three pieces as per NHS recruitment guidelines.

Please keep these safe as they will need to be verified in your online interview. Documents need to be sent to sc-tr.volunteervaccinesteward@nhs.net.

View ID Requirements.

Proof of ID upload - three separate forms of ID are needed.

Individual Health Assessment

Date of birth *

Do you fall into any of the groups below?

Shielding and/or extremely vulnerable

From 1 April, if you have been identified as clinically extremely vulnerable you will no longer be advised to shield. However, you should continue to take extra precautions to protect yourself. It is important that you continue to keep the number of social interactions that you have low and try to limit the amount of time you spend in settings where you are unable to maintain social distancing. Staff who fall into the clinically extremely vulnerable group as described by PHE should inform their manager and discuss their individual working arrangements

Clinically extremely vulnerable (as per above) *

Yes No

Over 70 (High risk) *

Yes No

People aged 60-69 *

Yes No

Men of any age *

Yes No

Pregnant women *

Yes No

Black, Asian, and Minority Ethnic (BAME) individual *

Yes No

Or have any of these underlying medical conditions?

Chronic (long term) respiratory diseases, such as chronic obstructive pulmonary diseases (COPD), emphysema, or bronchitis *

Yes No

Chronic heart disease, such as heart failure *

Yes No

Chronic kidney disease *

Yes No

Chronic liver disease, such as hepatitis *

Yes No

Chronic neurological disease, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), a learning disability or cerebral palsy *

Yes No

Diabetes *

Yes No

Problems of the spleen, for example sickle cell disease, or removal of spleen *

Yes No

A weakened immune system as a result of conditions such as HIV and AIDS, or medicines such as steroid tablets *

Yes No

Being seriously overweight – a body mass index (BMI) of 40 or above *

Yes No

Is there anything else you think might impact your volunteering? *

Yes No

Please tick one of the options below – I have: *

More than one of the above (high risk)
One of the above (medium risk)
None of the above (low risk)

Please use this box to provide any further information

Occupational Health

Do you have any illness/impairment/disability, either physical or mental, which may affect this volunteer role? *

Yes No

Have you ever had any illness or disability which may have been caused or made worse by this volunteer role? *

Yes No

Are you having, or waiting for treatment (including medication) or investigations at present? If your answer is yes, please provide details of condition, treatment and dates? *

Yes No

Do you think you may need adjustments or assistance to help you to undertake this volunteer role? *

Yes No

If you have answered yes to any questions please give details below.

Consent and declaration

I agree to attend an occupational health assessment, if necessary, and will give my permission to the Occupational Health Department to request any information that may be required from my General or other Medical Practitioner. I understand that this information will be used to assess fitness to undertake this volunteer post. I certify that I have answered all questions truthfully and that I am not aware of any medical reason that would prevent me from carrying out the duties required of me in the volunteer post for which I am applying.

I have read the Volunteer Privacy Notice and I am aware of the uses of information.

I declare that all of the above statements and information is true to the best of my knowledge.

Consent and declaration *

Yes No

Thank you for completing and submitting your application. A member of the Voluntary Service team will endeavor to be in touch within 72 hours. We will be sending you a couple of further documents and will be arranging an online interview with you soon very soon.