Address Line 1
Address Line 2
Occupation (include previous occupation if retired)
Emergency Contact Full Name
Emergency Contact Phone Number
Your previous volunteer experience
What did you enjoy most about this experience?
Hobbies, Skills or Special Interests
Languages Spoken / Understood
Particular cultural / religious affiliations
Do you hold a current police check suitable for aged care?
Yes No – If no we will assist you
Have you lived in a country other than Australia at any time since you turned 16 years of age:
Yes No – If yes you must complete a statutory declaration
Do you prefer to work in groups or 1:1 with residents?
Do you prefer to work alone or with a partner?
What attracted you to this facility?
What would you like to get out of this volunteer experience?
Days preferred for volunteering:
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Upload any supporting documentation:
Confidentiality Agreement: I understand that any information I have access to during the course of my work as a volunteer is private and confidential. I agree not to discuss information about the facility with anyone not authorised to have access to that information. I agree to be bound by the facility code of conduct and understand that failure to abide by facility guidelines and code of conduct may result in termination of my position as volunteer. I have received a copy of the code of conduct and Volunteer handbook.