ÐÏࡱá > þÿ ƒ … þÿÿÿ  €  ‚ ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿì¥Á € ø¿ dO bjbjöàöà Û ”Š ”Š Ÿ ÿÿ ÿÿ ÿÿ · – – Ù Ù ÿÿÿÿ 8 U t É Ü :, 0 ¥ ¶ [ " } } “ á Þ ¿ Û  ‰+ ‹+ ‹+ ‹+ ‹+ ‹+ ‹+ j- ¢ 0 ‚ ‹+ i k  ^ Ý k k ‹+ Ù Ù } “ ì ô+ O" O" O" k R Ù   } ¹ 8 “ ‰+ O" k ‰+ O" O" V Ñ) @ y @ ñ •* “ ÿÿÿÿ )?£MÏ ½ R * u+ , 0 :, * x Ž0 !   Ž0 •* Ž0 •* à k k O" k k k k k ‹+ ‹+ ¯!   k k k :, k k k k ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ Ž0 k k k k k k k k k – Ÿ : Volunteer Application Form Please complete all parts of this application form and give full answers. The more information you provide, the easier it will be for us to match you to a suitable role. 1. VACANCY DETAILS Role applied for: FORMTEXT D a t e : F O R M T E X T 2 . P E R S O N A L D E T A I L S T i t l e : F O R M T E X T S u r n a m e : F O R M T E X T F i r s t N a m e ( s ) : F O R M T E X T A d d r e s s : F O R M T E X T H o m e T e l : F O R M T E X T F O R M T E X T M o b i l e T e l : F O R M T E X T F O R M T E X T E m a i l : F O R M T E X T P o s t c o d e : F O R M T E X T W o r k T e l : F O R M T E X T D a t e o f B i r t h : F O R M T E X T M a k e o f C a r ( d r i v e r s o n l y ) F O R M T E X T 3 . B A C K G R O U N D P r e s e n t O c c u p a t i o n ( i . e . e m p l o y e d , r e t i r e d , c a r e r e t c ) : F O R M T E X T P r e v i o u s w o r k e x p e r i e n c e ( i n c l u d i n g a n y v o l u n t a r y w o r k ) F O R M T E X T I n t e r e s t s , h o b b i e s a n d s k i l l s F O R M T E X T I n t h e l a s t 2 y e a r s , h a v e y o u e x p e r i e n c e d t h e d e a t h o f s o m e o n e c l o s e t o y o u , o r h a d a n y o t h e r d i s t r e s s i n g p e r s o n a l e x p e r i e n c e ? F O R M T E X T D o y o u h a v e a n y h e a l t h p r o b l e m s o r d i s a b i l i t i e s w h i c h m i g h t h a v e a n i m p a c t o n y o u r v o l u n t e e r i n g ? I f s o , p l e a s e s p e c i f y . F O R M T E X T 4 . I N F O R M A T I O N I N S U P P O R T O F Y O U R A P P L I C A T I O N W h y a r e y o u a p p l y i n g t o b e a h o s p i c e v o l u n t e e r ? F O R M T E X T H o w d i d y o u h e a r a b o u t b e i n g a v o l u n t e e r a t D o r o t h y H o u s e ? F O R M T E X T 5 . R E F E R E N C E S T h e n a t u r e o f t h e w o r k f o r t h e H o s p i c e c a n b r i n g v o l u n t e e r s i n t o contact with vulnerable people. For this reason, we ask for the names of two people who have known you for at least two years, who are not relatives and not residing at the same address. Your signature will be taken as agreement for us to contact the following. Name FORMTEXT ! Ï Ð Ñ Ò ö ÷ êж¨™‡|q_Q_B_+_ ,j hÏry hÏry 5CJ OJ QJ U^J aJ hÏry 5CJ OJ QJ ^J aJ hÏry hÏry 5OJ QJ ^J #hÏry hÏry 5CJ OJ QJ ^J aJ hB`_ 5OJ QJ ^J hÏry 5OJ QJ ^J #hÏry hÏry 5CJ$ OJ QJ ^J aJ$ hÝR… 5CJ$ OJ QJ ^J aJ$ hÏry hÕ$ß 5OJ QJ ^J 3j hÏry hÕ$ß 5OJ QJ U^J mH nH sH u3j hÏry h;¡ 5OJ QJ U^J mH nH tH u*j hB`_ OJ QJ U^J mH nH tH u ! Ï Ð ã D F ú ñ ñ ñ ë æ ë Ú Ú Z  kdè $$If –l Ö ” Ö0 ”ÿbú( Î €˜ t àÖ0 ÿ ÿ ÿ ÿ ÿ ÿ ö 6ö ö Ö ÿ ÿÖ ÿ ÿÖ ÿ ÿÖ ÿ ÿ4Ö 4Ö l aö ytÏry dh $If gdt&