Safe Shelter Shoalhaven
Volunteer Application Form
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
Date of Birth
-
Day
-
Month
Year
Date Picker Icon
Gender
*
Male
Female
Are you a member of a church? If yes, which one?
*
Emergency Contact Details
Name
*
First Name
Last Name
Relationship
Phone
Other Information
Do you have a Drivers Licence?
*
Yes
No
Do you have First Aid Qualifications?
*
Yes
No
Other
Do you have a current Mental Health First Aid Certificate?
*
Yes
No
Other
Working with Children Check
If you do not have a Working with Children Check, you will need to apply for one.
Apply for Working with Children Check
Do you have a Working with Children Check?
*
Yes
No
Other
What is your Working with Children Check Number?
*
Working with Children Check Number
Working with Children Check EXPIRY DATE
*
Please provide WWCC EXPIRY DATE
Do you have any medical issues that might impact on your volunteer involvement?
*
What previous volunteering experience do you have, and with what organisation?
*
Additional Comments
Availability
Rows
4pm-10pm
10pm - 9am
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
I hereby agree that the personal information on this form will be used for the purposes related to the Safe Shelter Shoalhaven. This information will not be disclosed outside of this. I understand that my volunteer duties may require a police check.
*
Please sign here
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