Date Format: DD slash MM slash YYYY
Roles within the Inpatient Unit, Day Hospice and Supportive Care will be subject to DBS clearance and satisfactory references. Some of our roles involving direct patient contact are exempt from the Rehabilitation of Offenders Act 1974.
Please complete the necessary information if required for the role. Please contact the Volunteer Team if unsure.
Please provide the names, addresses, email address and telephone number of two referees. For retail, only one reference is required. These should be from someone that can vouch for your suitability and capability to be able to carry out the role. This must be someone that has known you for at least two years. We cannot accept references from family members.
Please provide an email address where possible as this will speed up the application process.
Parent or guardian consent declaration
This is required for all volunteers under the age of 18 years old. Please provide the name and relationship of your parent or guardian and we will be in touch.
If you are interested in volunteering as part of a Duke of Edinburgh Award or for work experience, please contact firstname.lastname@example.org. Please do not use this form.
Emergency contact details
Please provide details of who you would like us to contact in case of an emergency.
Information governance and declaration
Criminal record declaration
If you have answered yes, you now have two options on how to disclose your criminal record
Option 2: You can disclose your record under separate cover provided that you tick the box below and send the details in an envelope to Ashgate Hospicecare, Ashgate Road, Old Brampton, Chesterfield, S42 7JD. The envelope should be marked CONFIDENTIAL and state your name and the details of the post.