Volunteer Application Form

Volunteer Application Form
Personal Details
Title *
Name *

First Name Last Name
Preferred name *

First Name Last Name
Gender *
Address

Street Address

Street Address Line 2

Suburb State

Postcode
No fixed address
Email *
Home Phone

Area Code Phone Number
Work Phone

Area Code Phone Number
Mobile number *
Birth Date *

Day Month Year
Age
Main language spoken
Other languages
Do you identify as Aboriginal or Torres Strait Islander? *
Country of birth *
Main language/s spoken at home *
Employment status *

Working FT Working PT/ Casual Retired Unemployed
How did you hear about South Eastern Community Connect (SECC)? *

Family member Friend SECC Website SECC Social Media GP referral Allied Health referral (e.g. Social Worker, Occupational Therapist) Community services agency or community centre (e.g. JNC, The Deli) My Aged Care NDIS referral Humanitarian Settlement Program referral Educational agency (e.g. School, TAFE)
Why do you want to volunteer with us?
Volunteer experience
Have you ever volunteered before? If yes, please list the one or two most recent organisations here.
Please describe the work you did in this role/ roles.
How long were you there?
Which volunteer activities are you interested in? *

Children's Activities Assistant Social Activities Assistant (Dementia Day Centre in Rushcutters Bay) Driver for the Flexible Respite Transport Service Medical Companion Home Visitor Marketing and Social Media Assistant Graphic Designer Videographer or Film Editor Journalist Toy Library Assistant
Do you have experience in a field, or specific skills you'd like to share? e.g. physical education, reception, IT, gardening
When are you available? *

Mon AM Mon PM Tue AM Tue PM Wed AM Wed PM Thu AM Thu PM Fri AM Fri PM
How often are you available? *

Flexible Daily Weekly Fortnightly
Number of hours per week you want to volunteer? *
Driving Details

* Only required for volunteer drivers
Do you have a driver's licence?

Yes No
If yes, how many years have you been driving?
Do you have your own car?

Yes No
Licence type/s held

Learners Provisional (P1) Provisional (P2) Full Licence
Class(es) of licence held

Car Rider Light Rigid Medium Rigid Heavy Rigid Heavy Combination Multi Combination
Emergency Contact
Name *
Mobile number (not yours) *
Relationship to you *
Referee
Name *
Daytime contact number *
Relationship to you *
Medical Conditions
Do you have a disability, impairment or condition that may preclude you from carrying out some of the volunteer roles? Tick all that apply. *

Intellectual/learning Psychiatric Sensory/speech Physical/diverse N/A
If yes, please specify:
Multimedia Consent
South Eastern Community Connect (SECC) may take photography, audio, and video recording throughout the duration of its programs and activities for multimedia content production which is typically used in organisational promotion and marketing in a range of platforms and mediums. Do you provide multimedia consent?
*

No, I do not provide multimedia consent Yes, I, as named above, consent to South Eastern Community connect and its agents (including without limitation, any photographer, interviewer, creative agency or media organisation) recording images of me during SECC events, programs and activities for promotional purposes. I consent to these images being used and disclosed to any person or organisation approved by South Eastern Community Connect, including without limitation, by publishing them as part of a book, poster, brochure or report, newspaper advertisement or article television advertisement or program, radio advertisement or program and including on the world wide web or any other social media. I agree that South Easter Community Connect and its agents may edit the images prior to publication, as they consider appropriate, without first consulting me.
Privacy and Confidentiality Policy:
SECC has a strict policy around issues of privacy and confidentiality. All files are securely maintained.Your name and personal details will not be given to any person or agency outside of the Centre without your informed and voluntary consent. Exceptions to this agreement involve:
- Where a child or young person under the age of 16 years is at risk of significant harm from abuse or neglect (e.g. a child or young person witnessing incidents of Domestic Violence)
- Where there is a serious and imminent threat to life and health of any person, including the person seeking a service (e.g. a person is at risk of hurting themselves or harming others)
- Where a person discloses information that would substantially assist in the prosecution of any offence punishable by 5 or moreyears imprisonment
- Where a worker is required to provide documents (e.g. a person's file) or give evidence under subpoena
All SECC staff can descrive these exceptions in more detail if you have any questions please make sure to ask.
Data Collection
SECC collects basic program statistics. The collection is for funding and reporting purposes. The collection never identifies individuals. The collection allows us to monitor service usage patterns across the years. It also allows us to report to our Board and the bodies that provide us with funding with service provision. At no stage is any identifying data provided to either the Board of SECC or to funding bodies. If you choose to not have this particular information passed on you are able to inform the worker. You will still be able to receive services from SECC. Do you consent to the collection of statistics for the purposes stated above on the condition that any collection will not identify you personally?
*

Yes No
Would you like to receive information about upcoming events and programs? *
Agreement and Acceptance

I understand and agree that:
• The work undertaken by South Eastern Community Connect (SECC) and the business of service users (clients) is strictly confidential and I will maintain and respect SECC and service user confidentiality at all times.
• SECC works with frail aged and younger people with disabilities and their carers, and we must ensure their safety at all times.
• I give permission for the referee specified above to be contacted.
• A Police Check will be undertaken and a Working with Children Check will be undertaken for work involving children.
• A NSW Licence Check will be undertaken for Volunteer Drivers
Signature

Clear
Should be Empty:

Volunteer Application Form

Personal Details

Volunteer experience

Driving Details

Emergency Contact

Referee

Medical Conditions

Multimedia Consent

Privacy and Confidentiality Policy:

Data Collection

Agreement and Acceptance