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Child and Family Services Application Form
Full Name
(Required)
First
Last
Address
(Required)
Street Address
Address Line 2
City
ZIP / Postal Code
Date of Birth
(Required)
DD slash MM slash YYYY
Email
(Required)
Contact No
What Role Are You Interested In?
(Required)
Meals on Wheels Driver
Homeless Centre Volunteer
Activities Leader (Day Care Centre - older people)
Activities Leader (Childcare Centre)
Literacy Assistant
Afterschool Tutor
Youth Club Leader
Other
Relevant Skills
(Required)
Social Care
Health Care
Working with Elderly
Children and Youth
Art and Music
IT
Finance
Governance
Education
Other Skills
Which Area Are you Looking to Volunteer in?
(Required)
West (Ballina)
Mid West (Limerick City)
South West (Listowel, Castleisland, Cork City)
South East (Waterford City)
East (Dublin, Kildare)
North West (Bundoran)
Availability
(Required)
What are your availability, days and times?
Do you have access to private transport? - Only Relevant to Meals on Wheels
(Required)
Yes
No
N/A
Personal Declaration
The work of the society may involve contact with children and vulnerable adults therefore we need to gather some information before proceeding with the application. Please Note: Individuals who have lived outside the island of Ireland for 6 or more continuous months since the age of 16 years are required to submit an original Police Clearance Certificate(s) from the country or countries of residence (with authenticated translation where necessary).
Have you ever lived outside of the island of Ireland for 6 moths or more, since the age of 16 years?
(Required)
Yes
No
Have you ever been charged/convicted of a criminal offence, in Ireland or abroad, or are you at present the subject of criminal charges?
(Required)
Yes
No
Details of convictions are regarded as sensitive personal data under Data Protection Law. The SVP will not use this information for any other purpose other than assessing your suitability for membership/volunteering with the organisation. The disclosure of an offence may not necessarily be a bar to volunteering/membership of SVP).
If yes, please state nature and date(s) of the offence(s):
(Required)
1st
(Required)
I confirm that there is nothing in relation to my conduct, character or personal background that would adversely affect any position of trust in which I would be placed by becoming a volunteer/member of the SVP
(Required)
2nd
(Required)
I understand that the information provided by me may be verified and I give permission to the SVP to make enquiry of others to determine my suitability as a volunteer/member
(Required)
3rd
(Required)
In the course of volunteering with the SVP I understand that I may be dealing with confidential information and I agree to keep such information in strict confidence and to use it on for the purpose of, or as directed by, the SVP.
(Required)
Consent
(Required)
I confirm that the information I have given is true and accurate in every respect.
(Required)
Signed
(Required)
Date
(Required)
MM slash DD slash YYYY
Full Name
(Required)
Data Protection Notice
The SVP maintains an electronic register of volunteer/members which serves as a record of current and past members of the SVP. Your personal data is used to support the organisation’s work with people in need and your role in the SVP. Occasionally the SVP may disclose volunteer/member details on a confidential basis to service providers carrying out administrative tasks on behalf of SVP. You have a right to ask for a copy of any personal data held about you and to have any inaccuracies in such personal data corrected. Please note that SVP may contact you with information about SVP volunteer/member events and other activities that may be of interest to you.
I am happy to receive information by:
(Required)
Email
Phone
Post
None of these
Name
This field is for validation purposes and should be left unchanged.
Keep up to date with SVP
Name
Email
I would like to sign up to receive the SVP newsletter by email. 'Before doing so you might like to see our
Privacy policy
'.
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