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. 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.

Referee 1

Referee 2

Rehabilitation of Offenders Act (1974) (Exemption Order 1975)

As you may be volunteering with children or adults with care and support needs, we need to ask:

Have you ever been convicted of a criminal offence?

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.  

I declare the information provided in this form is correct. 

I consent to my information being stored by Healthwatch Cambridgeshire and Peterborough.  

I consent to being contacted by Healthwatch Cambridgeshire and Peterborough in relation to this application. 

This information will be used in line with our privacy statement. This is available here or please ask us for a copy. 

About you

Where do you live?
How old are you?
What was your sex recorded at birth?
How would you describe your gender identity?
How would you describe your sexuality?
How would you describe your ethnicity?
Do you have a disability?
Do you have a long-term condition?
Do you provide unpaid care or support for a family member or friend?