LGBT Cymru Helpline ~ C/o 92 Corporation Avenue ~ Llanelli ~ SA15 3SR Tel: 01792 828057 ~ Email: line@lgbtcymruhelpline.org.

uk ~ Web: ww.lgbtcymruhelpline.org.uk

VOLUNTEER APPLICATION FORM

This form should be used by anyone wishing to volunteer for the LGBT Cymru Helpline Full Name Address Post code Telephone Mobile Email

For use in emergency only Name of Next of Kin Contact Telephone

Position Applied for Your availability (please tick as appropriate) MON TUE AM PM EVE WED THU FRI SAT SUN

Please tell us about your work experience, qualification and skills including any voluntary
work What type of work are you interested in doing? Any other information to support your application Rehabilitation of Offenders Act 1974: Do you have any unspent convictions? Yes No

If yes, please specify

References If you have worked in the past five years, at least one reference should be obtained from your last employer. If not, give the names of people who you know well. Referee One Name Address Tel

In what capacity do you know referee one? Referee Two Name Address Tel

In what capacity do you know referee two? Declaration I understand that any offer of volunteering with the LGBT Cymru Helpline is subject to satisfactory references, and binding in honour only. In accordance with the 1998 Data Protection Act, I agree that the LGBT Cymru Helpline may hold and use personal information about me for volunteering reasons and to keep in touch with me. This information, including that contained in this form can be stored on both manual or computer files. It will be held securely and only accessed by authorised personnel. Please tick this box if you agree to the above statement. Signature Date

If you are submitting this application by e-mail, you will be asked to sign you application in person.

Confidentiality Undertaking Full Name

I undertake to treat all information concerning the LGBT Cymru Helpline (including information relating to any member, client, service user, or associate of the organisation), which comes to my knowledge during the course of my involvement as a volunteer, as strictly confidential. I further undertake that I will not, during the course of my involvement as a volunteer (except in the proper performance of my duties) or thereafter, divulge any such confidential information to any third party whatsoever nor will I make use of such information for my own or another persons benefit. I further undertake that I will use my best endeavours to prevent the use or disclosure of such confidential information to third parties. I understand that a breach of this undertaking may result in my dismissal and/or legal action. Signed Dated

If you are submitting this application by e-mail, you will be asked to sign you application in person.

Notes Confidential Information includes (but is not limited to) all documentary and other information relating to the LGBT Cymru Helpline, its members, clients, service users and associates, potential members, clients, service users and associates, including documents, new business plans and information regarding spending, details of finances and staff, design, product details, and future product ideas and other such documentation and information which the LGBT Cymru Helpline specifies from time to time as confidential information. This undertaking is without prejudice to the terms and conditions of your volunteering involvement with the LGBT Cymru Helpline relating to confidentiality.