LVRC Voluntary Work Application Form

Confidentiality Statement
Please note all the information given on this form remains confidential to Liverpool Volunteer Resource Centre and the organisation. Only statistics may be given to funding bodies

Surname:

Name:

Address:

Suburb:

Postcode:

Email:

Telephone No:

Best Time to Contact You:


1. Date of Birth:  Male Female


2. Please tick your current situation (Please tick all that apply):
Centrelink Payment
 Employed (full time) Aged Pension Employed (part time) Carers Allowance Home Duties Disability Support Pension Retired Low Income Supplement Student Low Income Family Supplement Unemployed (less than 12 months) New Start Allowance Unemployed (more than 12 months) Parenting Single Self Employed Youth Allowance Permanent Residency Work For The Dole Bridging Visa Work Development Order Traveller Other


3. Culture:

Country of Birth:

 Non English Speaking Background Aboriginal/Torres Strait Islander

Please list languages spoken:

Do you have a disability?  Yes No

If yes, please give details:


4. Background and Skills

Education Background:

Previous Occupation:

Current Occupation:

Skills:

Your reasons for volunteering:


5. Hobbies and Interests

Previous volunteer experience:  Yes No

If yes, when and for which organisation:

Is there a particular type of volunteer work you would like?

Is there a person or group with whom you are particularly interested in working? (Tick all that apply):
 Adults Seniors Teens Children People with Disabilities Males Females Mental Health Consumers Migrants No Preference

Are there any groups you would not feel comfortable working with?  Yes No

(please specify)


6. Availability

What days are you interested in volunteering? (Tick all that apply)
 Monday Tuesday Thursday Wednesday Friday Saturday Sunday AM PM

Time available:

Suburb(s) preferred for voluntary work:

Transport:  Public Private Vehicle Other

Private Vehicle Insurance Cover:  Yes No

Class of Licence:  Car Bus Other


7. How did you hear about the Liverpool Volunteer Resource Centre?
 Google Search Phone Book Organisations Go Volunteer Employment Service Previous Contact LVRC Website School/College/Uni/TAFE Friend/Word of Mouth Print Media/Newspaper Health Professional Other


8. If the position required it, would you be willing to undergo a Police Check?
 Yes No
Please be aware some organisations require a 100 point Identification Check.


9. Please list the name and phone number of 2 character referees (other than family)

a. Name:

Phone No:

b. Name:

Phone No:


I agree to my name and contact details being forwarded to the Agency of my choice.


Applicant's signature
(enter your full name):

Date:
(enter current date):