Habitat for Humanity Ireland - Volunteer

Habitat for Humanity Ireland - Corporate Partnership

You are here: Home » Test

Test

Save my progress and resume later

| resume a previously saved form

Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Your Email:

A Password:

Application Form

PLEASE NOTE THAT YOU WILL REQUIRED TO PAY A NON-REFUNDABLE DEPOSIT (via PayPal using a Credit/Debit Card/PayPal account)

Required fields are marked with an asterisk (*)

To complete the application form successfully you must have at the ready:

Your passport details
Your emergency contact details (next of kin)
Your Doctors details
Your reference details

Are you applying as a *

DESTINATION(S) AND DATES

By indicating this destination I confirm that I am able to travel during the listed dates, and if accepted I commit to being an active member of this team, attending at least three team meetings before the trip and participating fully in team life during the trip.

Destination & Dates (First Choice) *

Destination & Dates (Second Choice)

YOUR DETAILS

First Name *

Last Name *

Gender *

Date of Birth *

Title/Occupation

Company/Organisation

Email Address *

Type of Email Address *

Home Phone *

Mobile Phone *

Work Phone
Please leave blank if you do not wish to be contacted at work

Fax

Preferred Phone *

HOME ADDRESS

Address 1 *

Town/City *

County *

Postal Code

Country *

CORRESPONENCE ADDRESS

(if different from Home Address)

Do you wish to be contacted at a different address?

Address 1

Town/City

County

Postal Code

Country

Address Type

PASSPORT DETAILS

*NB Your passport must be valid for at least 6 months beyond the trip return home date.

Full Name as on Your Passport *

Passport/ID number *

Passport Expiry Date *

Nationality *

GENERAL DETAILS

Do you have any special dietary requirements? *

Examples: Vegetarian, Gluten Free, etc.

If yes, please list the requirements below
Examples: Vegetarian, Gluten Free, etc.

Do you have a first aid qualification? *

Do you speak any foreign languages? *

Which languages do you speak? How would you describe your ability in each language?

If you are accepted on this team, are you willing to speak to the media bout your participation in the trip? *

MEDICAL DETAILS (Confidential)

Disclosure of your medical details does not necessarily prevent you from participating in a GV team. Any hospital or medical practitioner not having access to your medical history will need the following information. These details will be confidential and only seen by your team leader and appropriate Habitat for Humanity Ireland staff. Please note that work assignment may be strenuous, and you may wish to consult your doctor about joining a team.

All successful applicants will be required to obtain written confirmation from their doctor that they fully fit to participate in this work trip.

Do you suffer from any allergies? *

Examples: food, medicine, bee strings, etc

Please list the allergies *
Examples: food, medicine, bee strings, etc

Are you currently taking any medications? *

Please list any medications you are currently taking and the conditions you are taking them for *

Have you had any serious heart, lung, kidney problems or any major illness or surgery in the last 3 years? *

If yes, please give details. *

Do you suffer from epilepsy, asthma, back problems, or other chronic illness? *

Please also list any other medical history which may be pertinent.

If yes, please give details * Please also list any other medical history which may be pertinent.

Do you have any physical impairment(s)? *

Please give details of any physical impairment(s) *

What is your Blood Group?

If Blood Group is not known it can be given at a later date!

What is the date of your last Tetanus shot?

Do you wear Contact Lenses? *

Are you willing to take and pay for all necessary immunisations and anti-malarial medication? *

EMERGENCY CONTACTS

Next of Kin

Name *

Address 1 *

Town/City *

County *

Postal Code

Country *

Home Phone *

Mobile Phone

Relationship to You *

Doctor

Name *

Address 1 *

Town/City *

County *

Postal Code

Country *

Telephone (Day) *

Telephone (Night) *

REFERENCES

Please provide the names of two individuals who can provide a character reference (at least one should know you in a professional context).

REFERENCE 1

Name *

Email *

Telephone (Day) *

Telephone (Night) *

Relationship to You *

REFERENCE 2

Name

Email

Telephone (Day)

Telephone (Night)

Relationship to You

DATA PROTECTION

Habitat for Humanity Ireland will hold the content of this application on file but will not release the information to any third party (Details will be shared with the team leaders).

From time to time you may receive information from Habitat for Humanity Ireland regarding Global Village opportunities and local builds. If you do not wish to receive these mailings please tick this box.

Do you wish to opt out of future mailings? *

Save my progress and resume later

| resume a previously saved form

Need assistance with this form?

Comments on this entry are closed.

"We believe in a world where everyone has a decent place to live."

Test

Application Form

Default Widget