Volunteer Application

Your Details

Given Name

Family Name

Date of Birth

Address

Post Code

Email address / Username

Here you can enter your email address if you have one, otherwise you may enter the username you would like to login to this site with. eg. john.smith

Phone

Home

Work

Mobile

Country of Birth

Languages Spoken

Work Experience

Are you currently employed?

Yes No

No. days/week

What is your current occupation?

Previous Occupations?

Interests / Skills / Hobbies

Do you drive?

Yes No

Do you have a car at your disposal?

Yes No

Do you have comprehensive car insurance?

Yes No

Licence No.

Expiry

What prompted this enquiry?

Why Calvary Health Care?

What roles at Calvary interest you?

Available for Interview

What time would you be available for a regular commitment as a volunteer?
(Usually 4 hours a week but can be negotiable)

Time

Early Morning Mid Morning Afternoon Evening

Health

How would you describe your present state of health?

Do you suffer any conditions which might affect your work as a volunteer?

Yes No

If yes, please specify

Are you on Work Cover?

Yes No

Are you currently involved with anyone who has a life threatening illness?

Yes No

If so, how would you see this affecting your work in palliative care?

References

Name of TWO people we may contact with your permission for a reference: (not family / friends)

Reference 1

Name

Occupation

Phone No.

Relationship

Email address

Reference 2

Name

Occupation

Phone No.

Relationship

Email address

Emergency Contact Information

Surname

First Name

Relationship

Phone No.

Security^*

Please complete the security check.

Calvary Health Care Sydney group volunteers

Available for Interview

What time would you be available for a regular commitment as a volunteer?(Usually 4 hours a week but can be negotiable)

Name of TWO people we may contact with your permission for a reference: (not family / friends)

Reference 1

Reference 2

What time would you be available for a regular commitment as a volunteer?
(Usually 4 hours a week but can be negotiable)