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Email
Do not have an email address
- Do not have an email address
Consent for contact via email*
I am happy to be contacted by the Hospice via email regarding Hospice News & Events and Volunteering opportunities.
Home Tel No
Mobile Tel No
Consent*
I understand that by completing this application my details will be stored in the database and I will be contacted by the volunteering team via my provided contact details

Health
How would you describe your health, physically and mentally?*
To support a diverse workforce this information allows us to make reasonable adjustments.
Please provide any relevant details about your health that may affect tasks you can complete.

Experience
What type of work, paid or unpaid, have you done in the past?
Please give details of any skills, interests or qualifications you have which you think might be relevant to the work you would like to do for us.
Regarding your bereavement history, Have you experienced the loss of a family member or anyone close to you within the last 12 months?
- Yes
- No
If yes, when?
Please provide details.

Roles and Availability
General Roles
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Fundraising Roles
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Shops
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Lottery
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Patient/Visitor Facing Role
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Any area
Other, please specify
How often would you be able to work as a volunteer?
Which days of the week are you available?
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Why did you decide to volunteer to work at East Cheshire Hospice?
Other Comments

References
We prefer to contact referees via email or phone, please provide these details where possible.
Referee 1 Name*
First Last
Address*
Street Address Address Line 2 City County Postal Code
Phone Number
Email
Referee 2 Name*
First Last
Address*
Street Address Address Line 2 City County Postal Code
Phone
Email
Comments
This field is for validation purposes and should be left unchanged.

Personal