Questionnaire

Your Volunteer Placement Programme is based on your individual skills and interests.
Each volunteer is required to fill out a Tsunami Generation Questionnaire that will assist Tsunami Generation
in getting to know you better and helping you get the most put of your placement.

Please complete the attached questionnaire and email it to:
lauren.godfrey@tsunami-generation.org
or post it to Lauren Godfrey at Tsunami Generation, 18 Spring Street, London W2 3RA.

We look forward to hearing from you!
 
  Personal details                                                                                       
Last name
(as on your passport)		 First Name
Occupation Role / Job Title
  Date of birth
(DD / MM / YY)       Male                  Female
  Ethnic origin: African Bangladeshi Chinese Caribbean
  Indian Pakistani White Other Asian
  Other Black Mixed Race        
  Correspondence
Address
  Postcode Email address
Phone Work Phone evening
Mobile Fax
  Criminal convictions can have a bearing on your eligibility to
obtain a visa to work in a different country. Have you ever
been convicted of a criminal offence in last 5 years?		 Yes No
Do you have any criminal proceedings pending? Yes No


If you have answered yes, please give details below or attach further details on a separate sheet.
(The Rehabilitation Act of 1974 (Exceptions) Order 1975 (as amended) states you do not
generally have to disclose details of spent convictions.
  Medical details
Do you have any disability or medical condition
if so, please state nature and give full details		 Yes No
Are you taking any form of medication?
If so, give details		 Yes No
Availability
Please tick the approximate time you would like to go on a volunteer programme
(you may tick ,more than one box)
Feb/Mar 2007  June 2007  July/Aug 2007  Sept 2007  Oct/Nov 2007 Nov/Dec 2007
 
  Interests
Please tick any of the following according to your interests:
  Interested
Culture and Sport
Civil society and Government
Education
Environment
Food, Agriculture and Animals
Health
Trade ventures and Entrepreneurship
Science, Technology and Innovation
Community welfare
  Education and Qualification
Please give details of any formal, trade or vocational training or education you have received from the age of 16.
Please detail your work experience starting with your most recent job working back through your previous jobs. Please attach your CV where possible.
1.From-To (Give Month & Year)
Name & Address of Employer
Type of business
Job title and full description of main duties and responsibilities
   
  2.From-To (Give Month & Year)
  Name & Address of Employer
  Type of business
  Job title and full description of main duties and responsibilities
 
   
  3.From-To (Give Month & Year)
  Name & Address of Employer
  Type of business
  Job title and full description of main duties and responsibilities
 
   
  4.From-To (Give Month & Year)
  Name & Address of Employer
  Type of business
  Job title and full description of main duties and responsibilities
 
  Are you in full time employment? Yes    No
Will this be taken from your annual leave entitlement? Yes    No
Do you think your company would be interested in corporate involvement? Yes    No
 
  References
Referees must not be related to you
Personal reference someone who has known you well in a social capacity for at least two years
Name
Address
Postcode Email
Home Telephone Number
Work Telephone Number
Occupation
How do they know you
 
Professional reference someone who can comment on your recent professional skills and has known you professionally for at least two of the past four years; e.g. current employer or client if self employed
  Name
  Address
  Postcode Email
  Home Telephone Number
  Work Telephone Number
  Occupation
  How do they know you
   
  Skills
Are there any specific skills you have - either work or non work related,
for example skills related to people / project management and social / community work
i.e. Agricultural, Health and Education or Sports qualifications
 
Please explain your reasons for working overseas as a volunteer
 
Have you ever been involved with any volunteer or aid agencies in the past, if so please detail
Yes    No
 
Would you be interested in taking part in a programme more than once, if so how often?
Yes    No
 
If you are selected 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 describe why
 
Where did you hear about Tsunami Generation, please tick (you may tick more than one box)
Friends / Family      Work     Website      Media      Past Volunteer
Other, please state
 
Declaration
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, please tick
I am willing to undergo a Police and department of Health record search, if required        Yes     No
  To send your questionnaire for processing, please click here
Once you have completed this questionnaire Tsunami Generation will be in contact within 5 working days.