EmailMe Form - VOLUNTEER INFORMATION FORM

Name *

First Last

Gender

Male

Female

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Telephone (Primary/Home/Mobile) *

(Secondary/Work)

How did you hear about the service? (Please select all that apply) *

Current Status *

Do you Recieve Pension? If Yes mention what type

Age group *

Do you have: *

What type of volunteer work are you looking for ? *

Your background *

Do you Identify as being Aborginal/Torres Strait Islander? *

Country Of Birth *

Nationality *

If not Australian, are you on a student visa ? *

Yes

No

Is English your first language? *

Yes

No

Main Language?

Other Languages?

Volume preference:

Client - one to one

Client - group

No direct client work

No preference

Do you have any special needs or medical issues that you feel should be considered in relation to your volunteer work?

No

Yes, Please specify

Suburb / local council area you prefer for volunteer work:

Manly

Waringah

Pittwater

Other (please Specify)

Availibility

Is there a particular time of day that suits you better?

Mode of transport you would travel to volunteer

Own car

Public Transport

Do you want to volunteer

Long Term (more than 6 months)

Short term (1-4 months)

One-off events

What are you hoping to gain through involvement in voluntary work?

Next Steps:

We will now contact one or two agencies and with your agreement, pass on the information contained in this form.

The agencies will talk to you further and, depending on the sort of volunteer work you are looking for, you may be required to provide references and undergo a police check.

I hereby give permission for the details contained in this registration form to be passed on to any organisation who may be interested in offering me volunteer work.

I understand that this information, without my name, may be used for statistical purposes. *

Yes

No