VOLUNTEER APPLICATION FORM

Personal Details

Full Name *

Date of Birth *

Phone Number *

Email Address *

What is your residential address? *

Street address *

City *

State *

Postcode *

Blue Card Number *

Blue Card Expiry *

Card Type *

Availability

If you have particular times you are available, please let us know below.

Monday Start Time

Monday Finish Time

Tuesday Start Time

Tuesday Finish Time

Wednesday Start Time

Wednesday Finish Time

Thursday Start Time

Thursday Finish Time

Friday Start Time

Friday Finish Time

Saturday Start Time

Saturday Finish Time

Sunday Start Time

Sunday Finish Time

Volunteer Roles

Please tell us of any roles in which you would be particularly interested *

Experience

Please give brief details of any work history (paid or voluntary) *

Please list details of any qualifications you may have *

Name of Referee *

Relationship to Volunteer *

Referee mobile number *

Length of time you've known them *

Criminal History Declaration – Working with Children (QLD)

Under the Working with Children (Risk Management and Screening) Act 2000 (Qld), individuals employed in child-related work must disclose any relevant criminal history. This declaration assists in assessing your eligibility for child-related employment and supports compliance with Queensland’s Blue Card system.

Please select one of the following *

I declare that I have no disqualifying offences, criminal convictions (spent or unspent), pending charges, child protection orders, or sexual offender orders relevant to the Working with Children Check (Blue Card), either in Queensland or any other jurisdiction.I declare that I have a criminal history that may be relevant to the assessment of my eligibility to work with children under Queensland legislation. I understand I must provide full details.

Acknowledgement

I understand that it is an offence under Queensland law to work with children without holding a valid Blue Card or exemption.I agree to notify my employer and Blue Card Services immediately if there are any changes to my criminal history during the period of my employment.I declare that the information provided above is true and correct to the best of my knowledge.

Disclosure of Pre-existing Injuries/ Medical Conditions

In accordance with the Workers’ Compensation and Rehabilitation Act 2003 it is requested that you disclose any pre-existing injury or medical condition suffered by you, of which you suspect or, ought reasonably suspect, would be aggravated by performing the nature of the duties in the proposed employment offered to you.

Note:

Section 571C(2) of the Workers’ Compensation and Rehabilitation Act 2003 will apply to a failure to make such a disclosure or the making of a false or misleading disclosure. Section 571C(2) states:

The prospective worker or any other claimant is not entitled to compensation or to seek damages for any event that aggravates the pre-existing injury or medical condition.

Any information provided on this form will be used for the purposes of Section 571C(2) of the (WCR Act only.

I declare that I suspect that I have the following pre-existing injuries or medical conditions:

OR

Signature

New volunteer to sign when complete.

Volunteer Name *

Date *

Signature *

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