Test for IE

Please complete the information below, which will be treated with confidence. If you have any difficulty completing this form, please phone Paula Smithson – Chaplaincy Manager on 07734 147314 or email chaplaincy@langleytrust.org

Please state which service you are applying for:

Service Name*

Personal Details

Name*

Date of birth*

DD/MM/YYYY

Email Address*

Contact Phone Number*

Address*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Why are you interested in volunteering with Langley ?*

Where did you hear about this vacancy?*

Your availability

How many hours would you like to give each week?*

Which days/evenings are you available?*

Your Experience

Using the Volunteer Chaplain role description as a guide:

1. Please tell us about:

any experience you have from church that is relevant for this role

how this experience will help you to fulfil the role of volunteer chaplain

Any gifts you feel God has given you that you would bring to this role

2. Please tell us about any other relevant qualifications, skills or experience with ex-offenders or other vulnerable groups.

Your Experience*

Church Involvement

Which church do you currently attend?*

How long have you been there?*

Please tell us about your current involvement in your church*

Additional information*

Please provide details of any needs that you have and would like us to take into account (e.g. disability, caring responsibilities etc). This information will be treated as strictly confidential.

References

Please provide the details of two people who have known you for at least three years, who can confirm your suitability for this role and who have agreed to provide a reference for you (eg a previous employer, voluntary work, colleague, or teacher) At least one of these should be a senior member of the church you currently attend who supports your application.

Reference 1

Name*

Role*

Address*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Email*

Phone*

How do you know this person?*

How long have you known them?*

Reference 2

Name*

Role*

Address*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Email*

Phone*

How do you know this person?*

How long have you known them?*

Criminal Record

Do you have any unspent criminal convictions or conditional cautions?*

Yes

No

DBS Check

Are you willing to undertake a DBS check which must be satisfactory to the Trust and to the level of the role?*

Yes

No

Relationships at Langley Trust

Are you related to any employee, Trustee or volunteer of the Trust?*

Yes

No

Important Information

By submitting this application, you consent to the Trust processing your personal data as necessary relating to your application or volunteering role with Langley Trust. This information will be used solely for purposes relating to recruitment and to your volunteering role.

Declaration

The information supplied in this application form is accurate to the best of my knowledge. I understand that any false declaration or misleading statement or a significant omission may lead to my volunteering agreement being terminated. I understand that my appointment is subject to interview, references and DBS check.

Signed

Date

We can only accept volunteers who are 18 years of age or older.*

I am 18 years or older

CAPTCHA

Please state which service you are applying for:

Personal Details

Your availability

Your Experience

Church Involvement

References

Reference 1

Reference 2

Criminal Record

DBS Check

Relationships at Langley Trust

Important Information

Declaration

How can we help?