Oxfam Ireland -Volunteer Registration Form Question Title * Please select the volunteer role you are applying for Retail Team Question Title * Please select below your preferred location to volunteer. Note, some locations may not have vacancies at all times, however we will work with you to offer an alternative opportunity, should your first preference not be available. RINGSEND, DUBLIN DISTRIBUTION CENTRE, DUNMURRY BRAY BLANCHARDSTOWN CASTLEBAR CORK (Cook Street) CORK (Frenchchurch Street) DUNDALK DUNDRUM DUN LAOGHAIRE GALWAY GEORGE'S STREET, DUBLIN KILKENNY LIMERICK MALAHIDE MULLINGAR NAVAN OXFAM HOME, FRANCIS STREET, DUBLIN (FURNITURE) PARLIAMENT STREET, DUBLIN (BOOKS) PHIBSBORO, DUBLIN PORTLAOISE RATHFARNHAM RATHMINES SLIGO TALBOT STREET TRALEE TULLAMORE WATERFORD WEXFORD BALLYHACKAMORE, BELFAST BALLYMENA BANGOR BOTANIC, BELFAST FOUNTAIN STREET, BELFAST COLERAINE CREGAGH ROAD, BELFAST DERRY DUBLIN ROAD, BELFAST (FURNIITURE) ENNISKILLEN HOLYWOOD LISBURN LURGAN NEWTOWNARDS OMAGH ORMEAU ROAD, BELFAST OXFAM BOOKS, ANN STREET, BELFAST OXFAM BOOKS , BOTANIC, BELFAST PORTADOWN Personal Information Question Title * Title Mr Mr/s Ms Miss Mrs Dr Fr Rev Question Title * Name Question Title * Surname Question Title * Gender Male Female Unknown Question Title * Date of Birth Date / Time Date Question Title * Contact Information E-mail Mobile Home Phone Question Title * Volunteer Address Address Line 1 Address Line 2 Town/City Postcode Question Title * County Co Antrim Co Armagh Co Carlow Co Cavan Co Clare Co Cork Co Derry Co Donegal Co Down Co Dublin Co Fermanagh Co Galway Co Kerry Co Kildare Co Kilkenny Co Laois Co Leitrim Co Limerick Co Londonderry Co Longford Co Louth Co Mayo Co Meath Co Monaghan Co Offaly Co Roscommon Co Sligo Co Tipperary Co Tyrone Co Waterford Co Westmeath Co Wexford Co Wicklow Other (please specify) Question Title * Country Ireland Northern Ireland United Kingdom Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Virgin Islands British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Hong Kong, SAR China Macao, SAR China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo (Brazzaville) Congo, (Kinshasa) Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and Mcdonald Islands Holy See (Vatican City State) Honduras Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea (North) Korea (South) Kuwait Kyrgyzstan Lao PDR Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia, Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint-Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint-Martin (French part) Saint Pierre and Miquelon Saint Vincent and Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic (Syria) Taiwan, Republic of China Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America US Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic) Viet Nam Virgin Islands, US Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe Question Title * Please select your preferred method of communication E-mail Mail Phone Question Title * How did you hear about the volunteer opportunity you are applying for Employability/ Benefits Scheme Employer Family/ Friend Local Paper Oxfam Ireland website School/ College Shop Window Social Media Question Title * Would you like to receive information on other Oxfam Ireland volunteer oppertunities Yes No Question Title * I would like to stay up to date with Oxfam’s activities (We will never share your contact information with anyone with anyone and you can unsubscribe at any time) Yes No Question Title * Please indicate below the day(s) on which you are available to volunteer Monday (am) Monday (pm) Tuesday (am) Tuesday (pm) Wednesday (am) Wednesday (pm) Thursday (am) Thursday (pm) Friday (am) Friday (pm) Saturday (am) Saturday (pm) Sunday (am) Sunday (pm) Question Title * I am applying to volunteer for a specific period as a student/ for work experience/ as part of a travelling/ cultural experience. Yes No If you have selected yes please state below the dates you request to volunteer Question Title * Tell us about any skills, qualifications or experience you have that may be relevant for this role Question Title * Please tell us why you chose to volunteer with Oxfam Ireland Question Title * Please let us know what additional needs you have, in order for us to support your volunteering experience Question Title * Emergency Contact Details Name Relationship to you Phone Question Title * Do you have a disability or additional needs for which you may require support while volunteering in this role? Yes No Question Title * Please let us know what additional needs you have, in order for us to support your volunteering experiance Question Title * In accordance with the Criminal Justice (Spent Convictions and Certain Disclosures) Act 2016 applicable in R.O.I., or Rehabilitation of Offenders Act 1974, applicable in Northern Ireland. Do you have any “unspent” convictions? Please note: N.I. - Rehabilitation of Offenders act 1974, UK: a conviction is described as “unspent” if the rehabilitation period associated with it has not yet lapsed; a rehabilitation period is a set length of time from the date of conviction, according to the sentence imposed. R.O.I. - Under the Criminal Justice (Spent Convictions and Certain Disclosures) Act 2016 a range of minor offences will become spent after 7 years. This means that an adult convicted of an offence covered by the Act does not have to disclose the conviction after 7 years, except in certain circumstances. The convictions which may be regarded as spent after 7 years are set out in Section 5 of the Act. Yes No If you have answered yes to the above question (please specify) Question Title * ReferencesSuitable references must have known you for at least 6 months and may include; previous employers, college supervisor/teacher, colleagues, co-volunteer landlord, case worker or social worker, priest, minister, friend. Please do not give the name of a member of your family or your partner. Please ensure all information is correct and accurate.Reference 1 First Name Surname Relationship to you Email Phone Number Address line Question Title * Reference 2 First Name Surname Relationship to you Email Phone Number Address Question Title * Volunteer Declaration I hereby declare that the information, which I have given on this form, is to the best of my knowledge, correct and gives accurate representation of my application. I understand that any false information may lead to the termination of my volunteering agreement.I understand that any offer of a volunteer position with Oxfam is subject to satisfactory references.In accordance with EU General Data Protection Regulation (GDPR), May 2018, I agree that Oxfam Ireland may hold and use personal information about me for volunteering personnel reasons and to keep in touch with me. This information, including that contained on this form, can be stored on both manual and / or computer files. It will be held securely and will only be accessed by authorised personnel. Yes No Done