Volunteer Application Form: Social Companionship

Your details

Name*

First Last

Address*

Street Address City ZIP / Postal Code

Phone*

Email*

Country of birth*

Languages spoken other than English*

Qualifications, skills and experience

Please list a short description of your relevant qualifications, skills and experience.

Qualifications*

Skills*

Experience*

Why would you like to volunteer for this particular role at North Richmond Community Health (NRCH)?*

Please let us know of any health, disability, religious, cultural factors or pre-existing injuries that you would like us to take into account as well as any medication you are taking which may affect your work.

What activities do you enjoy?*

Social Visits
Going to Cafes
Walking
Cooking
Shopping

For what period would you like to undertake volunteer work with NRCH?*

3 months
6 months
Until I get experience
Until I find employment
Ongoing

What day/s and times are you available?*

What is the distance you are willing to travel to meet resident from your home to meeting point? Please include mode of transport eg. 15 minutes by car*

Do you mind if the resident has a pet in their home?*

Assisting with pet-care is not a part of the role

Do you have a current Working With Children's Check?*

Yes
No

We will let you know if a WWCC is required

Do you consent to a police check?*

Yes
No

Resume

Please upload your resume to this application (optional)

Max. file size: 128 MB.

Referee 1

Referee's full name*

First referee's phone

Referee's email

Referee's relationship to you?*

Referee 2

Referee's full name*

Referee's phone

Referee's email

Referee's relationship to you?*

Emergency contact person

Full name*

Phone*

Address*

Street Address City ZIP / Postal Code

Relationship to you*

Declaration

By ticking this box, I declare the information I have provided on this form is true and correct. I declare that I have read and understood the Social Companionship Volunteer Position Description and understand what is required of this role.

Date*

What will happen next?

If your application is successful, you will be invited for an interview.

Queries

Please contact our Volunteer Services Coordinator with any queries. Mail: North Richmond Community Health Ltd, 23 Lennox Street, Richmond 3121 Ph: 9418 9893 Fax: 9428 2269 Email: volunteer@nrch.com.au Web: www.nrch.com.au