Online Application Form

Please complete the Online Application Form below with your details.


    First name(s) *

    Last name (* required)


    Street address (including house or flat) *

    Address line 2 (if applicable)

    Local area *

    Town or City *

    Postcode *

    Email address *

    Mobile Number

    Home Telephone Number

    Daytime Telephone Number (if Different)

    Person to Contact In Case of Emergency *

    Emergency Contact Telephone *

    If you have any illness or disability of which you would like us to be aware, please give details:


    Please give details of any existing work/voluntary commitments:

    Please give as many alternatives as possible. Flexible times can be arranged. Please indicate weekdays morning or afternoon.

    Evenings (are you also available evenings):


    What skills and experience can you bring to Headway?

    Previous employment, voluntary work, training, relevant personal experience, interests (brief details please):


    Why do you want to be a volunteer with Headway?

    What do think Headway can offer you?

    Have you ever been convicted of a criminal offence?:

    If YES please give date and conviction:


    Please give us the names and addresses of two people who can be asked to provide references. References will not be taken up until after interview.

    Referee 1

    Name *

    Address *

    Postcode *

    Telephone number *

    Email address *

    Referee 2

    Name *

    Address *

    Postcode *

    Telephone number *

    Email address *

    Headway Central Lancashire aims to promote equality of opportunity for all with the right mix of talent, skills and potential. We welcome applications from diverse candidates. Criminal records will be taken into account for recruitment purposes only when the conviction is relevant. Unless the nature of the work demands it you will not be asked to disclose convictions which are ‘spent’ under the Rehabilitation of Offenders Act 1974. Having an ‘unspent’ conviction will not necessarily bar you from volunteering. This will depend on the circumstances and background to your offences.

    As Headway meets the requirements in respect of exempted questions under Rehabilitation of Offenders Act 1974, in positions for which it is appropriate, potential volunteers will be subject to a criminal record check from the Disclosure and Barring Service (DBS), before their acceptance is confirmed *unless the volunteer already has undergone a recent check. This will include details of cautions, reprimands or final warnings, as well as convictions.