Volunteer Application Form Volunteer Application form First names: * Surname: * Date of birth: * Address: Town/city: Post code: Telephone: E-mail: Ethnicity Are you registered with a doctor? Yes No If Yes please give the Name of your GP and Surgery: Position applied for * Full & valid driving licence? * Yes No Own transport? Yes No Are you available for two or more hours per week? Yes No Do you speak any other languages? Yes No If yes, please state: Do you have a personal history of substance misuse? * Yes No How long have you been dry/clean? * Substance use history: * Do you have, or have you ever had, close contact with people with substance misuse problems? * Yes No Substance misuse history. * Do you have any disabilities or impairments that we need to be aware of? Yes No If yes, please state: Do you have any convictions? Yes No If yes, please state: Have you previously volunteered? Yes No If yes, please give details: Please tell us why you would like to become a Bridge Volunteer: Hobbies/interests/skills: Comments: References: We require a reference to proceed with your application. Referees must be over 18 years old and not a family member. They can be a previous employer/voluntary organisation, leader or colleague of any groups you belong to, tutor/ lecturer etc. Referee's name: * How do you know this person? * Organisation: * Address: Telephone: Email: Next of Kin: Please give details below: Full name: Relationship: Telephone: Address: Submit If you are human, leave this field blank.