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Application to be a Volunteer

* Compulsory field

Area applied for as volunteer:	*

PERSONAL INFORMATION
Title:
Surname:	*
First names:	*
Preferred name:	*
Other names you are known by:
Contact details
Residential address:
Postal (if different):
After work:
Work hours:
Mobile:
Email:	*

GENERAL INFORMATION
Do you speak or read any languages other than English?
	Yes No
If yes, please give details.

AVAILABILITY FOR VOLUNTEER WORK
Do you have any commitments which need to be taken into account when using your services as a volunteer?
	Yes No
If yes, please give details.

If accepted, when could you start?


DRIVING
Do you have a full current driver's licence?
	Yes No
If yes, what classes?
Date issued:
Expiry date:
Does your licence have any demerit points for endorsements?
	Yes No
Are you awaiting hearing of any charges for driving offences?
	Yes No
Please give details:


CONVICTIONS AND PROCEEDINGS
Have you ever been convicted of a criminal offence or are you awaiting charges in a criminal court of law? (This does not include convictions that are subject to the clean slate scheme of the Criminal Records (Clean Slate) Act 2004.)
	Yes No
Please give details:


If offered appointment, do you agree to authorise the council to obtain a copy of personal information held on you by the Department of Courts?
	Yes No

HEALTH
Have you had, or do you have, an injury or medical condition caused by gradual process disease or infection (e.g. hearing loss, sensitivity to chemicals, repetitive strain injuries) that the tasks of this job may aggrevate or contribute to?
	Yes No
Please give details:


Would you require any alterations or additions to your work area in order to perform your duties satisfactorily?
	Yes No
Please give details:


Are you prepared to abide by the requirements of the Health and Safety in Employment Act 1992 and subsequent regulations?
	Yes No

DECLARATION
I declare that, to the best of my knowledge, the answers to the questions in this application are correct. I understand that if any false information is given or any material fact withheld, I may not be accepted, or if I am employed, I may be dismissed. *

Email me a copy of my application

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Application to be a Volunteer

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