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Upside Pathways Volunteer Application Form
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* Indicates required question
Title
Your answer
First Name
*
Your answer
Last Name
*
Your answer
Address
*
Your answer
Suburb
*
Your answer
State
*
Your answer
Postcode
*
Your answer
E-mail Address
*
Your answer
Phone Number
*
Your answer
Mobile:
Your answer
Emergency Contact Information
In an emergency, please contact:
*
Your answer
Emergency Contact Relationship
*
Your answer
Emergency Contact Phone Numbers
*
Please list all contact numbers so we can find your contact in an emergency
Your answer
Medical Information
We at Upside Pathways have a duty of care to protect your health and safety while you volunteer with us. Your answers to these questions will help us meet our mutual needs
I would like to discuss this further
Do you have an existing disability/condition/injury? Please provide details.
Your answer
Do you take any medications that may affect your work?
Your answer
Do you have a current working with children check?
*
Choose
No, but I'm willing to apply for one
Yes, volunteer
Yes, professional
Yes, I have teacher registration
Working with children check number?
Your answer
Do you hold a current drivers license?
Manual
Automatic
Heavy Vehicle
NA
Clear selection
Skills and Qualifications
Please list skills you are willing to share
Your answer
Formal Qualifications?
eg. Diploma, Degree, Trade
Your answer
Other Training/Certificates
eg Current first aid
Your answer
Computer, Web, Ofice or Admin Skills
Your answer
I am volunteering to
*
teach a course
provide assistance in the kitchen
provide office support on site
Other:
In a few words, please describe the kind of course or service you would like to deliver:
Your answer
If volunteering to deliever a course, please detail numbers of hours per week, over how many weeks you are volunteering.
eg. 1 hour per week over 6 weeks,
Your answer
Preferred number of participants
eg 1 hour group class of 4, 3 x 1/2 hour lessons for 2 students at a time
Your answer
What kind of space do you require?
Small room, large halll, other
Your answer
What kind of supplies, equipment or other materials do you need or will you bring?
Your answer
Please describe your availability
Tuesday afternoon
Tuesday evening
Wenesday afternoon
Wednesday evening
Thrusday afternoon
Thursday evening
Saturday
Other:
Clear selection
I have read the statement of purposes for Upside Pathways Inc. and agree to respect them
*
Yes
No
I wish to discuss these further
I declare the information in this application is true and correct
*
Yes
No
I understand that I will be required to particpate in an interview as part of the selection process, undertake a working with children's check, and may be required to undertake some training such as understanding safety procedures, food handling etc.
*
Yes
I wish to discuss this further
Date of these declarations
*
MM
/
DD
/
YYYY
The personal information provided on this form will not be shared with any person or entity outside of Upside Pathways Inc. management, except in the event of an emergency for your own safety
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