Connect – Volunteer application form

Your Name (required)

Your Address (required)

Your Email (required)

Your Telephone (required)

Your Date of birth (required)

Your Nationality (required)

Do you require a permit to work in this country? (required)

References

Please provide us with the details of two people who can give you a character reference. These referees should not be a relative. Please name two people who have known you for at least two years

Reference 1 Name (required)

Reference 1 Address (required)

Reference 1 Email (required)

Reference 1 Telephone (required)

How do you know this person? (required)

Reference 2 Name (required)

Reference 2 Address (required)

Reference 2 Email (required)

Reference 2 Telephone (required)

How do you know this person? (required)

About You

Please tell us what interests you particularly about volunteering at Leeds Survivor-Led Crisis Service?

We work with callers in a trauma-informed way which means working creatively to build up trust with callers who may communicate in many different ways with us to express their crisis. Tell us what personal qualities or experience you would be bringing to the role to build these relationships with callers.

We offer a very supportive and rewarding volunteering experience. In return, we are seeking volunteers who are willing to offer their time and also to work on their practice and take on board any feedback offered. How do you feel about receiving feedback on your work, and can you tell us about a time you have taken on board some challenging feedback?

Please give details below of any convictions for Criminal Offences including spent convictions under the Rehabilitation of Offenders Act 1974. We are not able to accept people who have Schedule 1 offences. All volunteers are required to complete a Criminal Records Check before volunteering can take place.

Diversity monitoring

This information is for monitoring purposes only and will not be kept with your file. It allows us to check that we are reaching a diverse range of communities in Leeds.

What is your gender?

—Please choose an option—MaleFemaleNon-binaryOther, please specify belowPrefer not to say

Do you identify as transgender?

YesNoPrefer not to say

Which age group do you belong to?

—Please choose an option—18-2526-3536-4546-5556-6566+Prefer not to say

How would you describe your ethnic origin?

—Please choose an option—White BritishWhite EuropeanWhite otherBlack CaribbeanBlack AfricanBlack otherIndianPakistaniMixed raceOther, please specify belowPrefer not to say

How would you describe your sexuality?

—Please choose an option—HeterosexualGayLesbianBisexualOther, please specify belowPrefer not to say

Would you describe yourself as having a disability?

YesNoPrefer not to say

If you answered yes, how would you describe your disability?

—Please choose an option—Physical healthEmotional/mental healthOther, please specify belowPrefer not to say

Which best describes your employment status?

—Please choose an option—Full-time workPart-time workFull-time parentUnemployedRetiredStudentOther, please specifyPrefer not to say

Would you describe yourself as a carer?

—Please choose an option—Yes – of someone with physical health problemsYes – of someone with emotional/mental health problemsYes – of someone with both physical and emotional/mental health problemsYes – of someone with other needsNoPrefer not to say

Finally, how did you hear of this service?

—Please choose an option—Big IssueYorkshire Evening PostLeeds City Council vacanciesOther, please specifyPrefer not to say

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