Section 1 – Personal information

Surname (last name)

Forename (first name)

Any previous surnames

Are you under 18 years old?

Yes No

If you are under 18 years old, we will also need a parental/carers/guardians consent form completing. We will collect this at the next stage.

Telephone

Please tick the relevant box regarding the type of telephone number you have provided

Home Work Mobile

Do you live, work, or study in Kirklees or Calderdale? (You can mark more than one)

Live Study Work

What is the postcode area of the place you live, work, or study?

Preferred method of contact? (Tick as many as apply)

Email Telephone Posy Text

I agree to my personal data being stored and used to contact me about volunteering with Healthwatch Kirklees and Healthwatch Calderdale. My information will not be shared with any third party.

Please tick the box below if you agree

I agree to the statement above

Section 2 – Interest and availability

Volunteer roles

Which of our volunteering role/roles are you interested in? Feel free to tick more than one. For more information please see individual role descriptions

Community engagement and outreach volunteer Online feedback collector Maternity & Neonatal Volunteer Champion – subject to completion of enhanced DBS, training and references Authorised representative/enter and view visits – subject to completion of enhanced DBS, training, and references

Choose In which local area are you interested in volunteering with us?

Kirklees Calderdale Wakefield (MNVP role-only)

What is your availability? Do you have any preferred days or half days that you would like to volunteer with us?

Section 3 – Reasons for applying to be a volunteer

There are no right or wrong answers.
If you feel a question does not apply, please mark it N/A (not applicable).

What interested you about volunteering at Healthwatch and what attracted you to the volunteering role you are applying for? (If you have ticked more than one volunteering role please identify which role you are talking about)

What would you personally like to gain from volunteering?

Why do you think you would be suitable for this volunteering role? This might include experiences or interest relevant to the volunteering role, or skills you can share.

We work and support people from all walks of life, making it important that our team embraces diversity?

Have you had any experience working, volunteering or spending time with diverse groups? (people of different ages, abilities, cultures, communities and backgrounds than your own?)

Have you ever volunteered before? How long for, where and when?

Is there anything else you would like to tell us about you?

Once submitted, the volunteer expression of interest form will be processed by the volunteer officer who will contact you directly (normally within 3 working days). All information provided in this form will be treated as confidential, and used only for the purpose of selection of Healthwatch Kirklees and Healthwatch Calderdale volunteers, and will be seen only by those directly involved in the appointment process.

We will need to gather further information at the next stage and some volunteer opportunities will be subject to a satisfactory DBS check. The volunteer officer will discuss this with you and explain what is needed.

Volunteer expression of interest form

Thank you for showing your interest to volunteer with us!

Section 1 – Personal information

Section 2 – Interest and availability

Volunteer roles

Section 3 – Reasons for applying to be a volunteer