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VOLUNTEER PLACEMENT APPLICATION FORM
PEOPLE WITH MANY DIFFERENT SKILLS AND EXPERIENCES CAN TACKLE DISADVANTAGE BY VOLUNTEERING WITH IAVH
We would like you to READ this application forms and fill then without skipping any information as outline below.
If you are ready to volunteer within the next 6 - 12 months, you can use this form to tell us about your qualifications, experience and personal circumstances.
We will assess:
Ÿ Whether a local partner is likely to ask for your skills
Ÿ Your readiness to live and work in a developing country.
You can help us make these assessments by filling in all the sections of this form fully.
We strive to store and process you data responsibly. Our Data protection practices and your rights under the Medical Reports Act and Data protection Act are described at the end of this form.
Please remember to include your Volunteer placement fee of $100 plus volunteer identification card of $30
FAMILY NAME: __________________________________________
OTHER NAMES: __________________________________________
OCCUPATION/PROFESSION: ________________________________
When completed, please return this form to:
IMANI AGAPE VOICE OF HOPE (IAVH)
PO BOX 1402 -40200
E-mail: iagape2768@yahoo.com KISII – KENYA
jnyachwaya85@gmail.com +254-725818747
1. PERSONAL DETAILS
Date of Birth
(day/month/year)
Gender
Nationality
Address
(the address you will be at for most of the next 6 -12 months)
Postcode
Daytime telephone number
Fax
Evening telephone number
Mobile
Email Address
Alternative
Correspondence Address
Postcode
Type of Address (home, family, friend, work or other)
Evening telephone number
Mobile
Other Email
Criminal convictions can have a bearing on your eligibility to obtain a visa to work in a different country.
Have you been convicted of a criminal offence in the last 5 years?
Do you have any criminal proceedings pending?
If you have answered yes, please give details below.
2. DISABILITY
IAVH welcomes applications from people with disability.
Do you consider yourself to have a disability?
3. AVAILABILITY
How much notice does your current employer need?
(From filling in the application form to going on a placement usually takes starting 2weeks on the received of the application forms . )
What is the earliest date you would be available to go on a placement?
The majority of placements last two years. Are you prepared to commit yourself for this period?
- If not, how long are you prepared to go for?
Have you ever submitted a volunteer placement application form to IAV before?
- If so, in which year did you apply?
What was the outcome?
4. FINANCIAL COMMITMENTS
We ask you to think carefully about the financial implications of working in a developing country for two years. Volunteers are NOT PAD.
Do you have any financial commitments? (for example life insurance, a mortgage, maintenance or student loan)
If so, how much are you committed to paying a month?
How will you meet these commitments if you become a volunteer?
5. RELATIONSHIPS
Working as a volunteer makes as many demands on your personal circumstances as on your professional skills. In our experience your personal circumstances can have a bearing on your success as a volunteer.
What is your relationship status?
(Single, with a partner (not co-habiting), Living with a partner, Engaged, Married, Divorced, Separated, Widowed)
Since?
6. DEPENDANTS/CARING COMMITMENTS
Do you have children under 18 years?
Are they living with you or dependent on you?
No of children
Their ages?
Is anyone else dependent on you for care or support?
If you have dependants, what arrangements will you make for them while you are on your placement?
7. COUPLES/PARTNERS
We will consider applications from couples. However, it is important to note that it usually takes longer to match and place couples. The reason for this is that most of our overseas partners ask for only one volunteer and it is difficult to find two placements in the same geographical location requiring the different skills of the couple. The prospect of getting a placement are higher if the couple is willing to consider that one of them may not be able to volunteer with IAVH.
If you have a partner, what is his or her name?
Volunteering Partners
Does he or she intend to apply as a volunteer?
What is his/her occupation?
Has he or she already sent in an application form?
If yes, when did he or she apply?
If applying as a couple please send both your forms stapled together. If your forms are sent separately IAVH will only consider the applications when both forms have been received.
Partners not applying to IAVH
Does your partner intend to:
Remain in your home country?
Accompany you?
Come to visit you?
If they intend to come to visit you, please give an estimate of their intended length of stay (in months)
8.REFERENCES
9.1 Personal Reference
Name
Address
Postcode
Work telephone number
Mobile Number:
Email
Fax
Occupation
How do they know you?
9.2 Professional Reference
Name
Address
Work Telephone Number
Mobile Number
Email
Fax
Occupation
How do they know you?
9.YOUR HEALTH
You will need to have a full medical examination before you can go overseas. To establish if you need initial medical clearance please answer the following questions;
Have you ever had any major illness, operation or accident?
Give Details and dates
Have you ever suffered from any psychiatric or psychological problem including stress, anxiety and depression?
Give Details and dates
Are you taking any type of medication including inhaled asthma medication?
Give Details and dates
Do you have any objections or allergic reactions to vaccinations?
Give Details and date
10. OTHER SKILLS
Volunteers often need experience in some of the skills below. In addition to particular professional competencies, please indicate the areas in which you have experience.
Management (including staff supervision, teambuilding, project co-ordinating, strategic analysis & planning, managing resources, developing systems and information management.)
Training (including on-the-job training and mentoring, 1:1 and group training.)
Advocacy (including lobbying, campaigning, PR, raising awareness, influencing.)
Monitoring and Evaluation (including quality assurance, impact assessment)
Fundraising
Working with Community Groups (including F.E colleges, after school clubs.)
Writing project proposals and reports
Working with HIV and AIDS
11.LANGUAGE SKILLS
Select any additional languages you speak and your level of ability:
A - Able to work/teach in language B - Advanced general ability C- Intermediate Ability D- Basic Ability
Language
Level of ability
Chinese
French
English
Kiswahili
Others:
12. IT SKILLS
Select any of these areas that you have experience in, and your level of competency.
Software Packages
Level
Programming Languages
Level
Excel
C++
Word
Visual Basic
Databases
Level
Networks, installation and maintenance
Level
Access
LAN (Local Area Network)
DbaseIV
Network Maintenance
SQL
Network Installation
Operating Systems
Level
Other IT Skills
Level
Windows NT / 2000
CAD / AutoCAD
Windows 95 / 98
Web Design
UNIX
Peripherals (installations and maintenance)
Email Administration
Please give details of any other IT skills you have that are not mentioned above, including any training courses that you have attended:
13.SUPPORTING INFORMATION
Why do you want to work in a developing country as a volunteer?
Which elements of your work experience would you most like to use as a IAVH volunteer?
Give details of any additional skills gained outside your professional work (including voluntary activities)
If you are selected, IAVH will endeavour to send you to the most appropriate placement. Are there any countries where you are not prepared to work, or is there any type of work you would not want to do? Please explain why.
Are you prepared to teach or train if your placement requires it?
Have you considered trying to obtain a leave of absence from your employer?
DECLARATION
I declare that to the best of my knowledge the information I have given is correct. I understand that, in the event of a successful application, it is IAVH policy to check Security (Police) and Department of Health records for volunteers who will be working with vulnerable people.
I declare that I have never been convicted of a sexual offence, or dismissed from a post working with children, the elderly or disabled for malpractice. I am willing to undergo the Security checks appropriate to my country of residence.
Signature: Date:
FOR RECRUITMENT OFFICE USE
ETHNIC ORIGIN MONITORING FORM
IAVH aims to make volunteer experience equally rewarding for all volunteers. To this end, IAVH is committed to attracting volunteers from a variety of ethnic groups, reflecting the ethnic diversity of our recruitment base in the UK USA and elsewhere.
By answering the following questions you will enable us to monitor recruitment and to provide appropriate support.
The information on this page will not be taken into account in any assessment of your suitability to be a IAVH volunteer.
Ethic Origin
How would you describe your ethnic origin?
ASIAN
African
Bangladeshi
Chinese
Indian
Pakistani
BLACK
African
Caribbean
MIXED
White and Asian
White and Black African
White and Caribbean
WHITE
British
Irish
Other (please describe):
RECRUITMENT INITIATIVES
What is the most recent advertisement or mention of IAVH you have seen or heard? How did you learn about IAVH? This will help us to assess how successful our various recruitment activities have been.
Advertisement
Local newspaper
Magazine
National Newspaper
Posters
Internet (state website)
Meet IAVH evening
IAVH Open Day
Show, Fair or Exhibition
Other organisations e.g. charities, volunteer bureau, library (state which)
Directories/books
TV
Radio
Someone I know
Returned IAVH Volunteer
IAVH Staff
Serving IAVH Volunteer
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