Volunteer Application Form Question Title * Personal Details Title (Mr. Mrs. Ms. or Other) Name (First Name, Last Name) Preferred Name Gender Address City/Town State ZIP/Postal Code Email Address Contact Number Question Title * Best Method of Contact Email Phone Question Title * AgePlease tick the appropriate box: Under 18 18-24 25-34 35-44 45-54 55 or over Prefer not to answer Question Title * QualificationsPlease provide the details (Intuition and Date of Attainment) of any relevant qualifications you may have; Formal Qualifications e.g Diploma, Degree, Trade Certificate etc Other Training/Certification e.g First Aid Certificate, Advanced Driving etc Question Title * SkillsPlease tick any relevant skills: Driving/Transportation Personal Care Musical Abilities Arts/Crafts Skills Administration Handy Person Gardening Computing Question Title * Other Skills (Please Specify) Question Title * Language Do you speak a language other than English? Yes No If yes, please specify Question Title * Previous Volunteering Experience Do you have any previous volunteering experience? Yes No If yes, please specify (Include Company, Type of Volunteering and Duration of Volunteering Experience) Question Title * Community Inclusion (Please Specify) Sports Recreation Hobbies Leisure Clubs Other Question Title * Availability Date available to commence: Date / Time Date Question Title * Date to complete service (if known): Date / Time Date Question Title * Commitment Hours (Per Week, Per Fortnight) Question Title * Please indicate the days and times you are available to volunteer between 6.00am and 8.30pm: Monday Tuesday Wednesday Thursday Friday Saturday Sunday Question Title * Preferred Location Please tick your preferred location; Kellam - Medina Grace - Baldivis (Female only) Dawson - Baldivis Scotford - Baldivis (Female only) Reserve - Spearwood Greenwich - Bertram (Female only) Dorchester - Canning Vale McKenzie - Samson Regal - Thornlie Head Office (HR, Finance, Marketing, Administration) Question Title * InterestsPlease tick the areas of interest to you; Administration Arts and Crafts Computing/IT Disability Support Fundraising Gardening Handyman One-off Projects Organising Social Events Social Support Transport Other Interests (please specify) Question Title * Application Questions (400 characters max) Please tell us why you want to volunteer with Mosaic? Please tell us why are you interested in this volunteer position? Question Title * How did you hear about us ? Please tick appropriate box: Volunteering WA Seek Facebook Tafe University Career Hub (Curtin, ECU, Murdoch, UWA) Community News Care Careers Mosaic Website Other (Please Specify) Question Title * Emergency Contact Details Name Relationship to Volunteer Address City/Town State ZIP/Postal Code Email Address Contact Number Question Title * Relevant Documentation We will send you an email requesting the following documents; Do you have a current National Police Clearance and would you be able to provide a copy upon request (less than six months old)? Yes No Question Title * Would you able to confirm your identity by providing at least one document upon request? (e.g Birth Certificate, Citizenship Certificate, Current Passport, Australian Driver License, Learner Permit, Tertiary Education Institution Photo Identity) Yes No Question Title * DeclarationI, declare that, to the best of my knowledge, the information provided on this form is true and correct. Signature Date Done