Area Representative Volunteer Application Form

  • 1. Role Details

  • 2. Personal Details

  • 3. Education Training and Development

  • Please provide your RCVS registration number, or details of your highest qualification
  • Learning Opportunities
    Please describe any learning opportunities you have undertaken (with dates undertaken) relevant to the role applied for e.g. mental health first aid course

  • 4. Work History

  • Please list your full paid employment history starting with your present or last employer.

    • Dates, Month and year started and ended

    • Employer’s name and address

    • Job Role and Duties undertaken

    • Reason for leaving

  • Please give details of any relevant skills and experience gained outside of employment e.g. voluntary work

  • 5. References

  • Please fill in the details below for two referees. One should be your current or last employer or, if newly qualified, your place of education. If you were known by a different name at the time please state this
    No reference will be requested without your consent
  • Please give us the details of your first referee.


  • Please give us the details of your second referee.

  • 6. Supporting Information

  • Use this opportunity to tell us how you meet the requirements of the person specification given for the post you are applying for. Tell us using examples from work, paid or voluntary, and any relevant life experiences. Explain why you are applying for this post.

  • 7. Declaration

  • I understand that false or misleading statements may be sufficient grounds for cancelling any agreements made, or for disciplinary action to be taken
  • I declare that the information I have given on this form is correct
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