Testing - Broome Diocese

DIOCESE OF BROOME

KIMBERLEY CATHOLIC VOLUNTEERS

APPLICATION FORM

This is an online form which when submitted will be avaiiable to the Broome Diocese Co-ordinator of Volunteers.
If you use this form you will have to provide copies of any requested documents in some other way.

Please note: A Western Australian Working with Children Check (WWCC) is required. This, however, is able to be applied for only in WA. If you have an Interstate WWCC, please provide a copy as an interim measure.

All information you provide in this application will remain strictly private and confidential and will only be used for the purposes of this application.

1. Family Name.... Given Name/s

Your Family Name Given Name/s

Preferred Name

2. Date of Birth

3. Gender

Male

Female

4. Address

Street Address City ZIP / Postal Code

5. Postal Address (if applicable)

Postal Address City ZIP / Postal Code

Landline

Mobile

Email Address:

7. Marital Status and name of spouse/partner (if applicable)

8. Do you have any children? If so, please list their names and ages

Name

Age

Where did you first learn of Kimberley Catholic Volunteers

9. Please list your hobbies and interests

10. Which areas of work or tasks interest you?

12. Formal and other Qualifications:

13. List Work Experiences or Skills

(that wouldbe useful as a volunteer)-ie. handyman, amateur welder, cooking, catechism teaching, administration, etc.

14. Have you previously done voluntary work?

Yes

Please specify when and where?

15. Have you lived in a remote location before?

Yes

If YES, please specify when and where?

It is very important that we are informed of any health concerns. This does not mean that you will not be accepted * You may be asked to provide a Medical Certificate from your current GP.

17. Do you require any special medication or regular medical assistance?

Yes

If yes, please give full details:

18. Have you any mental or physical disabilities that may affect your work as a volunteer?

Yes

If Yes please give full details

20. Do you attend regular Mass and Sacraments?

Yes

Frequency

21. Please indicate the length of time you would like to volunteer for (6 months/12 months/longer). Add comments if desired.

22. When is the earliest you could commence? (Enter Month and Year)

23. Are you prepared to accept, and abide by the Diocesan Code of Conduct (See Join Us menu item)?:

Yes

24. Are you prepared to work as part of a team?

Yes

Do you have a current Driver's licence?

Yes

Class(es)

State

25. Do you have a current Australian Federal Police Clearance?

Yes

25. Do you have a current Working with Children Check?

Yes

Please list two referees: 1..(Parish Priest or a person involved in Ministry and 2.. A work or personal Referee)

Name of Parish Priest or Ministry Worker Referee

First

Occupation

Landline

Mobile

Name of work or personal Referee

First

Address

Street Address

Occupation

Landline

Mobile

Volunteer (1)

DIOCESE OF BROOME KIMBERLEY CATHOLIC VOLUNTEERS APPLICATION FORM

It is very important that we are informed of any health concerns. This does not mean that you will not be accepted * You may be asked to provide a Medical Certificate from your current GP.

Please list two referees: 1..(Parish Priest or a person involved in Ministry and 2.. A work or personal Referee)

DIOCESE OF BROOME

KIMBERLEY CATHOLIC VOLUNTEERS

APPLICATION FORM