Thank you for your interest in volunteering with Community Connections Befriending. It provides a lifeline to many isolated and lonely Lewisham residents (and those living in care homes in Southwark) who would otherwise have little or no contact with other people. This vital service would simply not be possible without the dedication of volunteers like yourself!

Please complete the application form below (you will need to be aged 18+ to apply) and someone from our team will be in touch with you shortly. You can also read and download the full role descriptions using the links below:

Role Description – Befriender

Role Description – Care Home Befriender (Southwark)

WHAT ROLE WOULD YOU LIKE TO APPLY FOR?

Please select one or both options below to let us know below which type of Befriending role you are interested in. You can read/download a full description of each role by using the links above.

I would like to volunteer for the following: *

• Befriender (Lewisham)
• Care Home Befriender (Southwark)

YOUR DETAILS:

Name *

First

Last

Date of birth *

Please enter as DD/MM/YYYY (you must be aged 18+ to apply)

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Gender *

• Male
• Female
• Other

Ethnicity *Arab or Arab BritishAsian or Asian British – BangladeshiAsian or Asian British – ChineseAsian or Asian British – IndianAsian or Asian British - PakistaniAsian or Asian British – Other Asian backgroundBlack or Black British – AfricanBlack or Black British - CaribbeanBlack or Black British – Other Black backgroundLatin American or Latin American BritishMixed – White and AsianMixed – White and Black AfricanMixed – White and Black CaribbeanMixed – Any Other Mixed BackgroundWhite - English/Welsh/Scottish/Irish/BritishWhite – Any other white backgroundPrefer not to sayOther (please specify below)

Please select one from the drop-down list above

If you selected 'Other' for your ethnicity please tell us your ethnicity here

Phone Number *

Email

Your Next of Kin

Please provide us with a name and contact details for your NOK, as well as stating their relationship to you (e.g. spouse, parent)

WHAT YOU CAN BRING TO THIS VOLUNTEER ROLE

What interests you about this role(s)? *

What days/times are you available to volunteer? (please select one or more of the following): *

• MONDAY - Morning
• MONDAY - Afternoon
• MONDAY - Evening
• TUESDAY - Morning
• TUESDAY - Afternoon
• TUESDAY - Evening
• WEDNESDAY - Morning
• WEDNESDAY - Afternoon
• WEDNESDAY - Evening
• THURSDAY - Morning
• THURSDAY - Afternoon
• THURSDAY - Evening
• FRIDAY - Morning
• FRIDAY - Afternoon
• FRIDAY - Evening
• SATURDAY - Morning
• SATURDAY - Afternoon
• SUNDAY - Morning
• SUNDAY - Afternoon
• ALL DAYS & TIMES

PLEASE NOTE: We need this information in order to successfully match you with a service user(s) who are also available during the day/time slot(s) you have selected.

Languages spoken *

Would you want to befriend someone over the phone and/or in person? *

How often could you commit to contacting a befriendee? e.g Weekly, Biweekly, Monthly *

What would you say to introduce yourself to a potential befriendee? *

What personal interests would you hope to share with a befriender? *

How many befriending relationships would you be happy to have at one time? *

N.B each relationship would require a 30-60 minute commitment per week

REFERENCES

Please provide the names and addresses of 2 referees, and tell us in what capacity you know them (at least one person should be of professional standing and NOT a family member). *If your circumstances mean that you can only provide 1 referee, or none at all, please still apply we will be happy to discuss this further with you.

1st referee name *

First

Last

1st referee address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

1st referee phone number *

1st referee Email

Relationship of 1st referee to you *

2nd referee name

First

Last

2nd referee address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

2nd referee phone number

2nd referee Email

Relationship of 2nd referee to you

Disclosure and Barring Service Checks

Depending on the nature of the voluntary work, you may be asked to undertake a Disclosure and Barring Service check. However, any information you disclose or we discover will not necessarily preclude you from volunteering.

CONSENT

Please complete the boxes below to confirm you give consent to process your application:

I consent to Age UK Lewisham and Southwark holding the above information about me and sharing my name and relevant information with clients. *

• Yes
• No

Date *

DD/MM/YYYY

Signature *

Clear Signature

How did you hear about us?

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