Broome Volunteer Resource Service Registration Form

Contact & Background Information

Title

Given Name/s

Surname

Date of Birth

Residential Address

Address

PO Box

City

State

Postcode

Phone

Email Address

Do you have access to transport?

Yes

Your Experience, Skills & Abilities

What skills/qualifications do you have?

Is there any work that you are unable to do for example Heavy Lifting?

Do you hold a White Card?

Yes

Do you hold a Working with Children Check?

Yes

Are you willing to apply for a WWC?

Yes

A BVRS staff member can help you with obtaining one at no expense when attached to a Volunteer Application.

Do you hold a National Police Clearance?

Yes

Are you willing to apply for a Police Clearance?

Yes

A BVRS staff member can help you with obtaining one at no expense when attached to a Volunteer Application.

Are you available for:

Statistical Data

(The following information is requested for statistical purposes)

How did you find out about us?

What languages do you speak/write?

What is your country of origin?

Are you an Indigenous Australian?

Yes

Are you from a non-English speaking background?

Yes

Do you have a disability?

Yes

If so, do you require any support?

Yes

(If so please state)

Are you volunteering as a part of a Centrelink obligation?

Yes

Would you like to attended a “Step into Volunteering” information session?

Yes

Learn more about the information session.

Would you like to receive emails from us regarding volunteering opportunities?

Yes

Your Volunteering Interests

(Please tick those options which best apply to you)

Availability

(Please tick which days and times you are available to volunteer)

I authorise this volunteer resource service to release information to member organisations in order to obtain a volunteer position and give consent to my details being entered into their database to be used for volunteering purpose.

Signature

Date

Some description about this section

	Morning	Afternoon	Evening
MON
TUE
WED
THU
FRI
SAT
SUN
Public Holiday