Volunteer Application Form Le Chéile MentoringVolunteer Application Form Volunteer Applications WebVolunteer Please tick the role(s) you are interested in *Volunteer Role:--None--Young Person Mentor Parent Mentor Restorative Justice Volunteer (Limerick only) Other/Administrative volunteer 1. Personal Details *First Name *Last Name Street Area/Town *City/County Eircode *Region you would like to volunteer:--None--Dublin Meath Cork Limerick & Clare Laois, Offaly & Kildare Waterford & South Tipperary Limerick RJ project Oberstown Phone Email Gender:--None--Male Female Age Range:--None--20-25 26-34 35- 47 48-60 60+ Emergency Contact Detail Emergency Contact Name: Emergency Contact’s Relationship to you: Emergency Contact Phone Number: 2. Volunteering Have you ever applied to volunteer or have volunteered with Le Chéile before?--None--Yes No Why would you like to volunteer: Please tell us what experience you may bring to the role?Here you can share your employment, skills, training, life experience or other qualifications that could help with volunteering. Please describe what experience or personal qualities you feel you would bring to the role. 3. Availability *Can you volunteer once a week for 2-3 hr:--None--Yes No *Can you give a 1 year commitment ?:--None--Yes No 4. Convictions Do you have a criminal record or charges:--None--Yes No Unsure (Answering 'yes' to this question will not necessarily disqualify you from volunteering with us. All offences must be noted if they occurred less that 7 years ago, while minor road traffic and other minor offences incurred over 7 years ago are considered ‘spent’ and may be omitted. Please see our Volunteering Information booklet for more information on whether you should list a charge or conviction) Details of criminal record or charges: Volunteer References Please provide the name and contact details of two responsible people willing to act as your referees. Le Chéile will contact referees directly if successful at interview. Please note that referees should not be friends or family members. Where possible we look for references from a current/most recent employer, volunteering organisation or academic institution Reference 1 Name: Address: Phone: Email: Occupation: Relationship to you: Reference 1 Name: Address: Phone: Email: Occupation: Relationship to you: 5. Declaration I declare that: All information provided, is true and accurate to the best of my knowledge. I have listed convictions and charges. I will inform Le Chéile without delay of any future convictions or charges I understand that if I break Le Chéile policy or if any conduct comes to light, which would bring my suitability to volunteer into question that I will be disengaged. I understand I may be re-vetted at any time while volunteering with Le Chéile. I understand that if successful at interview, Le Chéile will contact the people I have given as referees. How did you find out about volunteering with Le Chéile? How did you find out about volunteering:--None--Media Radio / Television Newspaper (please state which newspaper) Word of Mouth Volunteer Centre (please state which Vol Centre) Leaflet / Poster Website (please state which web site) Other If other, plese state: Data Protection Statement: Le Chéile will keep your application until recruitment is completed, and unsuccessful applications will not be retained. Some anonymous information may be used for statistical purposes or equality monitoring purposes. Safeguarding Statement: Le Chéile is committed to the safety and well-being of young people and vulnerable adults. Le Chéile will report to all relevant authorities any person who attempts to undertake volunteering work with Le Chéile while they are disqualified from or prohibited from being with or near young people or vulnerable adults. Mentoring Requirements: Because mentoring can be activity based, mentors should be in good physical health and able to manage and undertake activities with their match.