Volunteers - Application Form

Gender *
Use of own car
Please remember to keep us informed of any changes so that our records are kept up-to-date

Occupational Health Disclosure

Please review and answer the following statements. (Please tick the answer that applies to you). *
If you do indicate that you have a health condition or disability then our Occupational Health Team will make contact with you before you start. Contact may also be made by Occupational Health if your references raise any health conditions or information which might affect your volunteering.


We do need to take up references so please give the names and addresses of two referees. If you are currently, or have recently been in employment or involved in any voluntary work, one of your references should be from that organisation. References must be from people who are over the age of 18 and who have known you for at least 2 years. Relatives or partners cannot act as referees.

Rehabilitation of Offenders Act 1974

The Rehabilitation of Offenders Act 1974 (as amended) helps rehabilitated ex-offenders back into work by allowing them not to declare criminal convictions after the rehabilitation period set by the Court has elapsed and the convictions become spent. During the rehabilitation period, convictions are referred to as unspent convictions and must be declared to employers.
The organisation aims to promote equality of opportunity and is committed to treating all applicants for positions fairly and on merit regardless of ethnicity, disability, age, gender or gender re-assignment, religion or belief, sexual orientation, pregnancy or maternity and marriage or civil partnership. The organisation undertakes not to discriminate unfairly against applicants on the basis of a criminal conviction or other information declared.
You are required to declare all current unspent criminal convictions or cautions (including reprimands and final warnings). You are not required to disclose convictions or cautions which have become spent.
As part of assessing your application, organisations will only take into account relevant criminal record and other information declared which is relevant to the position being applied for.
Answering yes to the question below will not necessarily bar you from volunteering. This will depend on the relevance of the information you provide in respect of the nature of the position for which you are applying and the particular circumstances. Please call us if you would like to discuss further, we are here to help.
Are you currently bound over or do you have any current unspent convictions or cautions (including reprimands or warnings) that have been issued by a Court or Court-Martial in the United Kingdom or in any other country? *

Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment) (England and Wales) Order 2013

The position you are applying for has been identified as being an 'eligible position' under the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 [the Exceptions Order] and, in certain circumstances, the Police Act 1997. As such, it meets the eligibility criteria for a standard or an enhanced disclosure to be requested through the Disclosure and Barring Service (DBS).
Both standard and enhanced DBS disclosure certificates contain information about any convictions, cautions (including reprimands and final warnings) which are not 'protected' as defined by the Rehabilitation of Offenders Act 1974 (Exceptions Order) 1975 (as amended). Enhanced disclosures may also include other relevant police information where this is deemed relevant to the position you are applying for.
Please be aware that the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment) (England and Wales) Order 2013 (S.I. 2013/1198) made amendment to the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 to provide that certain spent convictions and cautions will become protected when specific conditions are met. Protected convictions and cautions will not be disclosed in a DBS check, and employers cannot ask for information about protected convictions or cautions, or take these into account when considering you for appointment. Before you complete the question(s) below please read guidance and criteria for the filtering of these convictions and cautions which can be found on the Disclosure and Barring Service website at: www.gov.uk/government/organisations/disclosure-and-barring-service
Where the position has, in addition, been identified as a regulated activity under the Safeguarding Vulnerable Groups Act (2006) (as amended by the Protection of Freedom's Act 2012) an enhanced DBS disclosure will include information which is held on the Children's and/or Adults barred list(s), as applicable to the position.
Please note that you do not need to tell us about convictions, cautions, warnings or reprimands which are deemed 'protected' under the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 as amended by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment) (England and Wales) Order 2013 - see notes above. You also are not required to tell us about parking offences.
Are you currently bound over, or do you have any convictions or cautions (including warnings and reprimands) which are not deemed 'protected' under the amendment to the Exceptions Order 1975, issued by a Court or Court-Martial in the United Kingdom or in any other country? *
Are you currently bound by any barring decision made by the Disclosure Barring Service (DBS) from working with children? *
Are you currently bound by any barring decision made by the Disclosure Barring Service (DBS) from working with vulnerable adults? *

Race relations (Amendment) Act 2000

* I would describe my ethnic origin as:

Asian or Asian British

Black or Black British



Other Ethnic Group

Membership of the Trust is about being involved in Dorset HealthCare. Anyone over the age of 11 years is welcome to join us to influence the decisions we make and strengthen links with our local communities. Membership is free and you'll also have access to great discounts through the shopping website Health Service Discounts. You can be involved as much or as little as you like. All volunteers are members of the Trust unless they opt out.
If you would like to be more involved as a member there are different activities you can participate in; such as, focus groups, conducting surveys, helping with staff recruitment and the induction training of new staff, taking part in quality audits and events to suit your interests.
Volunteers and staff will automatically receive a copy of our monthly bulletin Trustlink to keep up to date with news and events.
I understand:
  • The appointment if offered will be subject to the information given on this form being correct
  • My obligations in respect of disclosure of information and that the appointment may be subject to a medical examination
  • I will not receive payment for my voluntary work
  • I understand that the voluntary work I do will be of a confidential nature and that anything I see or hear must be treated with the strictest confidence. My volunteering may involve issues and situations of a sensitive nature and I agree to maintain confidentiality at all times.
  • The Trust complies with the terms of the Data Protection Act 1998. All information held is in a confidential manner.
  • I must abide by the Dorset HealthCare University NHS Foundation Trust volunteer guidelines.
  • Volunteers are bound by the Health and Safety at Work Act.
  • The Trust reserves the right to request a Disclosure and Barring Service check (previously CRB disclosure) at any time during your volunteer service.
Signature *