Personal information

    Full name (incl. title)
    Day tel. nos.
    Evening tel. nos.
    Occupation (if applicable)
    Date of birth
    (If you are under 18 years of age, please ensure a parent/guardian signs the closing declaration.)

    Emergency contact

    Full name
    Contact tel. nos.
    Email (mobile and landline)
    Relationship to applicant

    Supporting information

    Have you previously been a volunteer with St John Ambulance?
    If yes, and in Guernsey please give approximate dates. If not in Guernsey please include country, region and unit details where possible.
    What aspect of St John Ambulance Guernsey appeals to you most?
    Have you any additional skills and/or qualifications that could be relevant to your role in St JohnAmbulance Guernsey?
    Additional interests

    Photographic consent

    During St John Ambulance Guernsey activities such as public duties, fundraising events, training or in-house meetings, photographsmay be taken for the purposes of promoting the charity's work, including editorial, advertising and general information provision. I hereby grant St John Ambulance Guernsey the right to hold such images of my person for such a purpose on its image database andpublish them in any of its print and electronic media output for an indefinite period of timeunless otherwise stipulated. I understand that the images will NOT be licensed for any use beyond the remit of St John AmbulanceGuernsey as stated above and will not be provided to any unconnected third person. I understand St John Ambulance Guernsey holds the copyrights and all other rights for the images.

    I give consent for such photographs to be taken and held as stated above.(Please circle)

    If you do not give your consent on this form you can ask for a specific model release form in the future.


    We require two referees who can vouch for you. One of these has to be a personal reference from someone who has known you for over five years and is not a relative. The other should preferably be from someone who has worked with you in a professional setting, such as a teacher, your current manager or leader of another volunteer organisation. By completing this section you give us permission to take up these references as part of the processing of your application form.

    Referee 1

    Full name
    Company or organisation (if applicable)
    Contact tel. no.
    In what capacity does the referee know you?
    How long has the referee known you?

    Referee 2

    Full name
    Company or organisation (if applicable)
    Contact tel. no.
    In what capacity does the referee know you?
    How long has the referee known you?


    As part of being a volunteer with St JohnAmbulance Guernsey you are required to complete a health declaration todetermine suitability for role. This is a separate confidential document between you and our medical team. The remainder of this sectionis voluntary and you are under no obligation to disclose any medical information on this form. Any information yougive will be used to ensure St John Ambulance Guernsey endeavours to meet any additional needs or requirements to the best of ourability.

    Ambulance before proceeding with your application? (Please circle)
    If so, can you tell us if we can do anything to assist to your needs? For example visualaids, access requirements.
    Do you have any medical conditions or allergies which you feel we would need to be aware for your own safety? For example asthma, nut allergy, diabetes, epilepsy.

    Criminal convictions

    As a volunteer you will have to have a Criminal Records Bureau check. In some cases this willbe enhanced. The remainder of this section is not compulsory. Do you have any criminal convictions you might like to discuss witha senior volunteer with St John Ambulance before proceeding with your application? (Please circle)

    Please note you will have to make an annual declaration of offences when you become avolunteer.

    Print name

    Applicant signature
    Signature of parent or guardian if applicant is 16-17 years of age