Application Form

GLOBAL VILLAGE APPLICATION FORM

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Application Form

Required fields are marked with an asterisk (*)

To complete the application form successfully you must have:

  • Your passport details
  • Your emergency contact details (next of kin)
  • Your doctor's details
  • Your reference(s) details



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.



YOUR DETAILS











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


HOME ADDRESS





CORRESPONDENCE ADDRESS

(if different from Home Address)








PASSPORT DETAILS





GENERAL DETAILS

Examples: Vegetarian, Gluten Free, etc.




MEDICAL DETAILS (Confidential)

Please note that the volunteer work assignment will be physically strenuous and mentally challenging and you may wish to consult your doctor about joining a team. 


It is necessary that you disclose any illnesses to Habitat for Humanity Ireland as HFH is limited in the support it can offer.


Disclosure of your medical details does not necessarily prevent you from participating in a GV team, however, you will be required to obtain written confirmation from your doctor that you are fully fit to participate in this work trip.


These details will be confidential and only your team leader and appropriate Habitat for Humanity Ireland staff will have access to them. 


Any hospital or medical practitioner treating you and not having access to your medical history will need the following information. 



Examples: food, medicine, bee strings, etc

Examples: food, medicine, bee strings, etc





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

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



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



EMERGENCY CONTACTS
Next of Kin









Doctor








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






REFERENCE 2






MARKETING




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 about our work in Ireland and around the world.


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