WORKING AT PALS Volunteer Application Form Personal DetailsName* First Middle Last Maiden/Previous Names Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Date of Birth* DD slash MM slash YYYY Email* Gender* Male Female Other Emergancy Contacts(Please supply details for 2 emergency contacts. These should be responsible adults who, for example, can assist you to travel if necessary)Name 1* First Last Relationship 1* Address 1* Street Address Address Line 2 City State Post Code Phone 1*Name 2* First Last Relationship 2* Address 2* Street Address Address Line 2 City State Post Code Phone 2*Volunteer RoleName of role/position for which you are applying AvailabilityDayMorning 9am - 1pmAfternoon 1pm - 5pmEvening 5pm - 7pmAll Day Are you interested in volunteering for one-off events? Yes No Do you have any impairment or condition that could be aggravated by doing the tasks listed in the Job Description? Yes No Details Do you have your own means of transport?* Yes No Do you speak/use other languages?* Yes No Which languages? Are you willing to undertake training if required?* Yes No As a NDIS Registered Provider, all staff and volunteers require the NDIS Worker Screening Check. Yes No Can you provide me further information The NDIS Worker Screening Check can be obtained via the Vic Services website: https://www.vic.gov.au/ndis-worker-screening-check This consists of a National Police Check and is now mandatory for all of our volunteers. Are you happy to proceed with obtaining the NDIS Worker Screening Check? Please identify the areas in which you would like to assist. Administration Holidays and Outings Shop front Clerical Computers/IT Customer Service Disability Support Maintenance Storeman Committee Member Events Fundraising Is there any other area where you would like to offer your assistance? RefereesPlease nominate two referees e.g. ministers, employers, adult educators (excluding family members) It is important that you seek permission from your proposed referees before we contact them. Please note that referees will be contacted by PALS IncName 1* First Last Phone 1*Name 2* First Last Phone 2UsHow did you hear about our Service?Why do you wish to volunteer?MedicalAre there any health issues/disabilities/courses of treatment or restrictions that may prevent you from performing particular types of activities or that we need to be aware of to provide appropriate support and assistance if required?Please provide information hereSupporting DocumentationCurrent Qualifications/ResumeMax. file size: 50 MB.CAPTCHAUntitled First Choice Second Choice Third Choice
