The AJR Volunteers' Application Form

Please note: all applicants are subject to the standard DBS (Disclosure & Barring Service) check.

Fields marked with * must
                    be completed.

surname:

forename(s):

gender:

female: male:

mobile phone no:

evening telephone no:

address:

postcode:

date of birth:

e-mail address:

how many hours per month can you spare?:

do you have access to a car?:

yes: no

are you a member of the AJR:

yes: no

if not, how did you hear of us?:

special interests/hobbies/skills?:

do you have any particular
                    preferences?:

Individual Befriending	Computer Help Service
Hospital Visiting	Specialised Dementia Project
The AJR Centre	Regional Groups

please provide the names of
                    two referees:

first referee name:

address:

postcode

second referee name:

address:

postcode