Selfless

Personal Details

First Name (required)

Surname (required)

Date of Birth (required)

Gender (required)
 Male Female

Contact Details

Your Email (required)

Telephone No.

Address

Next of Kin

Name (required)

Relationship (required)

Email (required)

Telephone No.

Address

Volunteer/Work Experience Details

Please list previous experience in date order starting with the most recent
Please include names of your employers/organisations along with a brief description of your role/duties.

Interests & Skills

Why would you like to volunteer with Selfless?

Please state what you would like to gain from your experience

Please list all languages spoken

Medical Details

Do you have any dietary requirements?
 Yes No

Any current or past medical illnesses or conditions?
 Yes No

Are you currently on any medication?
 Yes No

Project Details

Which project are you applying for?
 Elective Aid Teaching Aid General Volunteering

If you are applying with a friend or partner please type their name(s) in the box below

Please upload your Curriculum Vitae (CV) below. Please zip if uploading more than one file

Declaration

If any false or misleading information is provided in this form you may be disqualified from appointment or if appointed you will be liable to be dismissed without notice.

I hereby declare that the information given in this form is accurate and complete and I have understood and complied with the requirements laid down in the previous paragraph. I agree that the information given on this form may be used for registered purposes under the Data Protection Act of 1998. I consent to the storage of the above information on manual and computerised files.

I accept the above statement