CASS Standard Application Form

Dear Applicant,

Thank you for expressing your interest in taking up a role with CASS. This online application form contains sections covering equal opportunity monitoring and declaration of offences. Please complete and submit the application form to us. On receipt of your application we will arrange a suitable date for you to come in to discuss the role further.We look forward to receiving your application.

Yours sincerely

Applied For Role:
Volunteer Management Committee Employment Apprenticeship Traineeship
If volunteering choose from the following: 
Practical assistance/DIY Gardening Befriending Administration Other-Please State

Where did you see the advertisement?: 

Name & Contact Details
Last Name:  First Name: 
Permanent Address:  
Temporary Address (if applicable):  
Telephone:  Telephone(temp): 
Confirm Email: 
Emergency Contact Details

Enter Secondary School. Dates of Attendance. Qualification(s) Attained
Enter College/Sixth Form School. Dates of Attendance. Qualification(s) Attained
Enter University. Dates of Attendance. Qualification(s) Attained
Enter your interest and other training relevant to the position you have applied for.

Employment / Background History
Please list starting with your present or most recent employment.
(Include employer name and address, dates of employment, position held, reason for leaving)

Supporting Statement / Please tell us how your skills will enable you to perform this role
Please tell us why would you like to be a volunteer and what do you hope to achieve

Suitable hours to volunteer - Only for Volunteers
When and how much of your time would you like to devote to voluntary work?
  Days    Monday  Tuesday Wednesday Thursday  Friday  Saturday  Sunday 
No Preference
How many hours a week? (Please select)
1 or 2
More than 2

Please provide the names and addresses of two referees who we may contact. For those seeking employment or Management Committee it must include your present or most recent work reference.
Reference 1
Confirm Email: 
Please indicate when may we approach them?
 After Interview
Reference 2
Confirm Email: 
Please indicate when may we approach them?
 After Interview
Please note for the protection of elderly, disabled and vulnerable people our organisation will carry out CRB checks, and take references.

Equal Opportunities Monitoring Form
CASS strives to operate a policy of equal opportunity and not discriminate against any person. Please complete this section as well. The form will be treated in the strictest confidence and will be detached from the application form before the recruitment process begins. The information supplied on this form is used for statistical purposes only.
Date of Birth:
Do you consider yourself to have a disability?:  
Yes No
If Yes, Are you registered disabled?:  
Yes No
Please give details about your disability below: 
Ethnic Origin & Cultural Background: 
Specify Other: 

Registered Charity No 1098224
This document is kept in strictest confidence and will only be seen by the interviewer.
CASS welcomes applications from all sections of the community including ex-offenders, as part of its equal opportunities policy. CASS volunteers will be working directly with elderly and disabled, with access to their homes. Not only clients but ex-offenders might be in a potentially vulnerable position unless considerations of a personís background have been made known from the outset.

For this reason, we ask you to complete the following section.

Have you ever been convicted of a criminal offence?:  
Yes No
If you have answered Yes, please give details of date(s) of offences and sentence(s) passed:

To the best of my knowledge, there is no reason in respect of my physical or mental health why I would not be able to volunteer for CASS.

I confirm that the information I have given on this form is correct and complete and that misleading statements may be sufficient grounds for not accepting my services as a volunteer.

Do you accept the Declaration? Yes No
Please note: The Rehabilitation of offenders Act 1974, certain occupations are exempt from the provisions of this act. As you may be in contact with persons under the age of 18 years or over the age of 65, persons who are blind, deaf or have a learning difficulty or mental illness, YOU ARE REQUIRED BY LAW to give brief details (sentence passed and the date) of each conviction even though "spent" under the Act.
If you have declared a criminal conviction that has some bearing on your role at CASS this will not be discussed with you at interview and does not necessarily preclude from being accepted.