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Volunteer Application Form
First name:
Last name:
Date of Birth:
Gender:
M ☐ F ☐ Other☐
Address:
Suburb:
Postcode:
Email
Home #
Mobile #
Emergency Contact:
Relationship;
Mobile #
Home #
Work #
Occupation/Voluntary
Experience:
Name & Contact details for two work/personal referees:
Name
Name
Company
Company
Phone #
Phone #
Is there any medical condition that would prevent you from performing certain types of work?
Yes
☐
No
☐
Details:
Record Checks, do you have….
A current Working with
children check
Yes☐ No☐
Senior First Aid
Certificate
A current National Police
Clearance
Yes☐ No☐
If NO do you agree to undergo a National Volunteer Police
Clearance (costs covered by UCW)?
Yes☐ No☐
A Current Drivers
Licence
Yes☐ No☐
Yes☐ No☐
CRIMINAL RECORD
A criminal record does not necessarily disqualify an applicant; however it is necessary to disclose any criminal history or pending cases for UCW to be able to
assess your application fully.
Have you ever been convicted of any offence Yes☐
in court, or are you currently the subject of any
No☐
charge(s) pending before any court?
If yes, please give details
of any such convictions
or pending charges:
NOTE: Commencement of volunteering will be subject to applicants either;A)
Completing an application for a National Volunteer Police Clearance (we lodge this on behalf of the applicant) prior to their commencement. Or
B)
Providing a valid National Police Clearance (NPC) prior to their commencement (must have been issued within the previous six months or less).
Should UnitingCare West become aware of any convictions or pending charges not declared that might otherwise have influenced the organisations
decision to appoint subsequent to an appointment being made, the volunteer may be terminated without further notice.
You are not required to provide details of convictions declared “Spent” under the ‘Spent Convictions Act’ 1988.
Reason for doing volunteer work
☐Make a Difference
☐Build my skills
☐Give back
☐Other
☐Teamwork
☐Keep Busy
How did you hear about UnitingCare West
☐Friend
☐Work
April 2016
☐Media
☐Other
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In which area would you like to volunteer? Please tick
Community Options
Supports adults and children living with a disability to maintain their
independent and wellness by participating in community based social
and recreational activities
☐Masterchef
☐Fit n Fun
☐Monthly Soiree
☐Voiceworks Plus
☐Social Clubs
☐Saturday Club
☐Teen Ace
☐Men in Sheds
☐Arts and Craft
☐School Holiday
Program
Community Connections Lunch Groups
Provides friendship to adults with a mental illness through lunch
groups.
☐Lunch group volunteer
☐Lunch Group Co-ordinator
Family Group Homes
Mentoring foster children living in a group home setting.
Food Rescue
Rescues perishable, fresh and nutritious food and provides food
parcels for clients
☐Mentor
☐Tutoring
☐Admin
True Colours (Bunbury)
Promotes safe and inclusive communities for young people with
diverse sexuality and/or gender in Bunbury and the South West region.
☐Safe Space Volunteer
CreditCare
Provides financial counselling and emergency relief
☐Emergency Relief
☐Financial Counsellor
Tranby Day Centre
Provides support to people who are homeless (or at risk of becoming
homeless)
☐Kitchen Assistant
Administration
Provide assistance with a variety of office procedures including filing,
archiving and mail outs.
☐Administration
The Warehouse Café
Provides people living with disabilities opportunities for training,
building life skills and moving into open employment.
☐Front of House/Barista
☐Kitchen/Waitstaff
☐Packer/Sorter
☐Driver/Buddy
☐Administration
☐Grant Writing
☐Cleaning
☐Fundraising
☐Maintenance
☐Events
☐Marketing
☐Other - please
indicate
Community Connections 1 to 1
Provides friendship to adults with mental illness through one to
one befriending.
☐Social Support
Family Foundations
Providing homeless families with support to get back on their
feet 2.30pm-6.30pm, Monday, Tuesday and Thursday
☐Play & Homework with Kids
☐Donations & storage sorting
☐Food Preparation
☐All of the above
Newpin
Provides support to mothers experiencing difficulties caring for
their children (up to 4 years)
☐Creche
Christmas Appeal – Giving Box
Provides gifts for children and food hampers to disadvantaged
families at Christmas
☐Sorter/Packer
☐Driver
☐Driver Buddy
Uniting Community House
Provides a social & recreational meeting place for marginalized
people in the Midland area, meeting each Friday evening for
socializing
☐Social Support
☐Meal Preparation
Events/Fundraising
Volunteers to be available for various positions during the year
☐Event Volunteer
Pathways
Providing social support to people who are homeless/at risk of
homelessness living with multiple issues.
☐Social Support Volunteer
Days Available:
☐Monday ☐Tuesday ☐Wednesday ☐Thursday ☐Friday
Hours available per day
All positions are subject to availability
Not sure what you would program you would like to be involved with?
Call and speak with UnitingCare West’s Volunteer Engagement Advisor on 9355 9039 or Email: [email protected]
Confidentiality Agreement
To protect individuals and the programs of UnitingCare West from unauthorised dispersal of information, I hereby undertake to treat any
information received as strictly confidential.
I understand that the completion of this application does not guarantee an offer of voluntary work with UnitingCare West.
Signed:
Return by
post to;
April 2016
Date:
People Services
UnitingCare West
GPO B74, Perth WA 6838
OR BY
[email protected]
Email to;
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