Volunteer Mentor Application Form – Merseyside Offender Mentoring Full Name and Title Address (Including Postcode) Date of Birth (You must be aged over 20 to apply for this role) Male Female Telephone E-mail Please detail below what personal qualities you think you have that would make you a suitable and effective mentor to work with offenders. What practical life skills and experiences can you bring to this role? Please include any relevant expertise in areas which would support offenders, e.g. peer support, drug or alcohol knowledge, mental health etc. Please give a short example of where you have dealt with a difficult or challenging situation or person. What skills did you use to get a positive outcome? Why do you want to volunteer as a mentor on this particular project? Do you have any experience of working or volunteering with offenders or ex-offenders? Yes No If yes please give details below Do you have any health problems or a disability which you feel might affect your role as a Mentor? Yes No If yes please give details below any ways in which we might support you. Are there any particular times where you are not available to volunteer? (We often need our Mentors to be available during the day to meet offenders on release and to accompany them to appointments during the week. Mentoring must be seen as a long term process so you and the mentee get the most out of mentoring) Disclosure and Vetting Because of the nature of the work Sefton CVS undertakes and the fact that our Volunteer Mentors will be working with vulnerable people, you are required by the Rehabilitation Offenders Act 1974 to declare all criminal convictions including those which are spent. Please detail therefore any such convictions, cautions or traffic offences in the space below. (Please note: a conviction will not necessarily be a bar to volunteering with Sefton CVS, however if you have any listed convictions we may contact you to clarify matters before processing your application.) Sefton CVS is a Disclosure and Barring Service (DBS) registered organisation. All volunteer applicants must complete an enhanced disclosure records check, to ensure the safety of the vulnerable adults with whom we work with. These checks are strictly confidential to registered Sefton CVS staff. Enter ‘none’ if you have no convictions. *We particularly welcome and encourage applicants from those with criminal records who can demonstrate their suitability as a Volunteer Mentor, however this does depend on the details of the offence(s) and length of time which has elapsed since those offences were recorded. Where did you hear about the Mentoring Project? Please tick the relevant box Do-it.org websiteCouncil BulletinNetworking EventCollege*PolicePartner ProjectNewspaper articleSefton CVS e-BulletinCVS MeetingUniversity*Through WorkplaceMember of CVS Staff Leaflet/PosterVolunteerChurch Group*Sefton Volunteer Centre Probation ServiceEvent Word of Mouth Community Centre*Prison ServiceOther Please give details of two referees who have known you for at least 2 years, preferably in a professional capacity. For example, your current/most recent employer, a recent academic reference or someone who knows you well. We cannot process your application without these details being added. *Please contact us if you need further guidance or clarification on who is a suitable referee. Reference 1 Name Address Tel(Day) Mob Email Capacity in which known How Long Reference 2 Name Address Tel(Day) Mob Email Capacity in which known How Long Privacy Notice: Merseyside offender mentoring project/Sefton CVS use your personal information in accordance with our Mission and Values for the purpose of delivering our services. We may also share your information with partner agencies where this is required for legitimate interests, for example supporting you in sending CV’s or job application forms to prospective employers. We and our partners are committed to maintaining your personal information in a manner which meets the requirements of the Data Protection Act (1998).This includes ensuring that your personal data is kept secure against unauthorised access, loss, disclosure or destruction; that it is not used by anyone for any incompatible reason without checking with you first; and that it is securely destroyed as soon as it is no longer needed. I confirm the information I have supplied on this form is correct Signed Date: Please return your completed application form to: Merseyside offender mentoring project Sefton CVS Third floor, Suite 3B North wing Burlington house Crosby road north Waterloo L22 0LG Email: Merseyside.mentoring@seftoncvs.org.uk Phone: 0151 920 0726 ext 231 Which of these best describes your ethnic background? Asian: BangladeshiIndianPakistani Other Asian background (please specify if you wish) Black: AfricanCaribbean Other Black background (please specify if you wish) Chinese: Chinese Other Chinese background (please specify if you wish) Mixed Ethnic background: Asian and WhiteBlack Caribbean and WhiteBlack African and White Other Mixed Ethnic background (please specify if you wish) White background: BritishEnglishIrishScottishWelshPolishLatvianGypsy/Traveller Other White background background (please specify if you wish)
