Personal Details
Known As
Mobile
Email
Who would you like us to contact in the case of emergency?
We understand that former hospice patients, clients, and carers, may wish to support Blythe House Hospicecare (BHH) by volunteering. We strongly recommend a gap of at least 12 months between the date of discharge from all Blythe House services and considering a volunteer role based at the hospice that will not compromise health and wellbeing. A gap of six months is recommended before considering a volunteer role based in one of our shops.
We also recommend that anyone experiencing bereavement allows at least 12 months to elapse from the time they were bereaved before considering a hospice-based role.
Please contact the Volunteer & Support Services Team at Blythe House if you wish to discuss other ways of supporting Blythe House.
Skills & Experience
Are you currently employed: Yes No Student Retired Volunteering Other
Please tell us about any relevant skills and experience – tick all that apply and detail below: High School College University Other
If Other Please State
Volunteer role(s) interested in
Which service/area are you most interested in supporting?
Other
Availability
If 'driver' selected, or you are driving on our behalf please provide the following information
Driving Licence Number:
Licence Expiry Date:
Driving Licence Code From GOV website so we can view details:
Insurance Company:
Insurance Expiry Date:
Insurance Policy Number:
About You
How did you hear about volunteering for Blythe House Hospice ( BHH )
What are your interests hobbies and or activities
Why would you like to volunteer for Blythe House Hospice ( BHH )
Please Supply Any Additional Information That Would Be Helpful Regarding Your Interest In Volunteering:
Do You Have Any Medical Conditions We Should Be Aware Of? Yes No
If Yes Please Elaborate
If Yes Please Explain
Reference 1
Please list two referees (not family - preferably one business and one personal)
A referee must be someone who has known you well for at least two years and is not your partner, relative or a current Blythe House volunteer, or staff member. Your referees must not live at the same address, and preferably not be known to each other.
Full Name:
Business / Personal: Business Personal
How Long Have You Known This Person And In What Capacity:
Telephone:
email:
Reference 2
Full Name:
Business / Personal: Business Personal
How Long Have You Known This Person And In What Capacity:
Telephone:
Email:
Disclaimer
I Confirm I Have The Right To Work As A Volunteer In The United Kingdom: Yes No
I Give My Consent To Receiving Information From Blythe HouseAnd Would Prefer To Be Contacted In The Following Way(s) Please Tick All That Apply: Email Phone Post
Data Protection
It will only be used to send you information from Blythe House and will not be shared to a third party for any marketing purposes.
Your personal data will be held securely.
If you wish to update your contact preferences at any time, please contact the Volunteer Team.
Our system will record your data and will be treated as confidential. It may be used for internal review and, if requested, to notify you about updates to the website. Blythe House Hospice will treat personal information sent as confidential. No personal information, including email addresses, will be shared with any third party for the purpose of marketing.
Confidentiality
All patients, clients, their families and carers have the right to expect that Blythe House staff and volunteers will respect their confidentiality.
All volunteers are required to treat all they know or learn about a client as strictly confidential. Confidentiality can be a difficult area and volunteers are encouraged to discuss any problems about confidentiality with the Volunteer Team or an appropriate senior staff member.
By signing this form you are confirming that you understand that during the course of your volunteering you will treat as confidential all information concerning current or former patients, clients, their families and carers and you undertake not to divulge any such information and if any doubt you will refer the matter to the appropriate senior staff member. Failure to respect confidentiality may result in you being asked to step down from your volunteer role(s).
I have read and completed this application form in full, and to the best of my knowledge all details are true.
Diversity Information
Please provide us with the following information to assist our efforts in monitoring the diversity in our volunteer team. By completing this form you are providing Blythe House Hospicecare with your consent to use your information for this purpose. Completing this form does not constitute any part of the recruitment and selection process.
Ethnic Group
