Volunteer Individual Application Form

* Mandatory Field

Personal Information

The following information is needed to ensure that we cover you under our insurance policy and offer you appropriate support services:

Title*
Given Names*
Surname*
Home Address
Line 1
Line 2
Locality/Suburb
State
Postcode
Postal Address

(if different from above)

Line 1
Line 2
Locality/Suburb
State
Postcode
Contact Numbers
Home
-
Business
-
Mobile
-
Email
Medical Information
Age Group*
Do you have a current First Aid Certificate?*
Do you have a current National Criminal History Record Check?*

(e.g. Child Related, Aged Care, Vulnerable Person)

Do you have any medical problems or are you taking any medication which may affect your volunteering?*
Contact Person for Emergencies
Title*
Given Names*
Surname*
Relationship to Volunteer*
Home
-
Business
-
Mobile
-
Volunteer Preferences
Which Council Program would you like to join? What day(s) would suit you to volunteer in the program?*
How did you hear about the (Council's Volunteer Program)?
Skills and Experience

It would be appreciated if you could supply the following information:

Do you have any experience in Volunteering before?
Do you have expertise in a particular field which you may like to share through volunteering? Please list:
Referees

It is Council policy to check references of all new Volunteers. Please provide details below:
(two referees, one business and one personal)

Business Referee
Title
Given Names
Surname
Company
Home Phone
-
Business Phone
-
Mobile
-
Relationship to Applicant
Personal Referee
Title
Given Names
Surname
Home Phone
-
Business Phone
-
Mobile
-
Relationship to Applicant
Other Comments
Other Comments
Important Information

Insurance

Please note that Council's indemnifier does not cover any person under the age of 10 or over the age of 90. Also any person that does not hold an Australian Medicare Card is also not covered by Council’s insurance policy for volunteers.

Port Augusta City Council Privacy Policy

Any personal details collected will be used only for the purpose of processing your registration, keeping records, and establishing your identity. The supply of information by you is voluntary. If you cannot provide or do not wish to provide the information sought, the Council may not be able to process your application. Access to the information is restricted to Council officers and other authorised people. Council is to be regarded as the agency that holds the information. You may make an application for access or amendment to information held by Council.

If you see this, leave this form field blank.
This is a printer friendly version of the following web page:-
http://www.portaugusta.sa.gov.au/page.aspx?u=1388