Adult Literacy Trust - Sample Form

Your Details

First Name:

Last Name:

Street Address:

Town/City Address:

Postcode:

Email Address:

Home Tel:

Mobile Tel:

Nationality:

English:

Is my first language

I am bilingual

Other (please specify)

Please state proficiency in English:

Date of birth (optional - you must be over 18 to apply):

Gender:

Male

Female

Availablity Commitment: Regular weekly basis

What are you able to commit on a regular weekly basis in term time only? (Please select all possibilities, but you will only be required to commit to one)

Which days are you available:

Mondays

Tuesdays

Thursdays

Which boroughs are you happy to visit:

Westminster

Hammersmith & Fulham

Please select from the following projects which match your criteria above:

Where	When	Time
[Project Name]	[Day of week]	[From time to To time]
[Project Name]	[Day of week]	[From time to To time]
[Project Name]	[Day of week]	[From time to To time]
[Project Name]	[Day of week]	[From time to To time]
[Project Name]	[Day of week]	[From time to To time]

Availability Commitment: Occasionally as a stand in

What are you able to commit to occasionally as a stand in in term time only? (Please select all possibilities, but you will only be required to commit to one)

Which days are you available:

Mondays

Tuesdays

Thursdays

Which boroughs are you happy to visit:

Westminster

Hammersmith & Fulham

Please select from the following projects which match your criteria above:

Where	When	Time
[Project Name]	[Day of week]	[From time to To time]
[Project Name]	[Day of week]	[From time to To time]
[Project Name]	[Day of week]	[From time to To time]

Supporting Information

The success of a Doorstep Library relies on the regular commitment of its volunteers. Can you commit yourself for a minimum of 9 months?

Yes

What are your current circumstances?
(Please describe any work, studying, or other commitments and how volunteering with us will fit in with these):

Will you be prepared to apply for a DBS police check?
(Please note: you will only be able to volunteer with us if you have a completely clear DBS check.)

Yes

Please indicate if you have any health condition that might affect this role:
(Volunteers need to be able bodied: They go up and down stairs carrying a small rucksack containing a reasonable load of books. They often sit on the floor. They spend time outside walking from one house to the next and sometimes reading on the doorstep.)

Where did you hear about us:

Professional Background

Please describe in detail your professional background:

Please describe your formal or informal experience with young children?

Volunteering Experience

Please describe any experiences of volunteering, including the duration and frequency of the placement:

Why do you wish to volunteer for Doorstep Library?
(All reasons for volunteering are valuable - explain so we can best evaluate if the Doorstep Library Network can fulfil your aspirations)

Skills and Qualities

Having read the Home Reading Volunteer Person Specification, please describe how your skills and qualities make you a good match to be a Home Reading Volunteer:

How would your friends describe you and why?

Do you have a favourite book from childhood?

References

Before inviting you for an interview, please provide the contact details of two references. Please note that at least one of your referees should know you in a professional capacity, and family members are not acceptable.
(N.B. If you are not a UK national, please provide a professional reference who has known you for at least 3 years.)

Reference 1 (Professional)

Name:

Tel:

Email:

Relationship:

How long has this person known you:

Reference 2 (Other)