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Volunteer Application Form
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Title
Mr
Mrs
Ms
Dr
Other
First names
Surname
Address
Post code
Daytime phone
Cellphone
Email
Date of Birth
Indicate which of our services you are interested in supporting, and which roles.
Services
PSEC
Enliven
Family Works
Real People
Preferred locations
Napier
Taradale
Havelock North
Hastings
Gisborne
Roles
Shop volunteer
Shop team leader
Office/administration
Enliven Centre support
Enliven Centre activity
Family Works donated goods/baking
Mosaic Centre support
Rowan House support
Event assistance
Street Appeals
Other
Please let us know how much time you'd be prepared to give
Frequency
Weekly
Fortnightly
Monthly
Other
Hours per session
1 to 2
3 to 4
4 to 6
more than 6
Morning
Afternoon
Evening
Days
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Why are you interested in volunteering with PSEC?
What experience or skills can you bring to the organisation?
Upload your CV (optional)
Do you have any medical conditions or physical limitations that may affect your work as a volunteer, or may affect your safety and that of your colleagues?
Do you have any criminal convictions, or are you awaiting the hearing of any charges in a court of law?
No
Yes
If yes, please give details
Do you consent to a full Police check?
Yes
No
Please provide a referee we can contact to establish your suitability for volunteering
Name
Relationship with you
Daytime phone
Cellphone
Our clients and families involved with Presbyterian Support East Coast are accorded confidentiality. As a volunteer with this organisation I agree to respect and maintain this trust.
I agree to my name and phone number being used with Presbyterian Support East Coast. The personal information contained in this form will be held by and remain confidential to Presbyterian Support East Coast.
Under the Privacy Act 1993, you have the right (with certain exceptions) to request access to, and correction of, any personal information held by us.
I declare that all the information provided by me in support of my application is correct.
I acknowledge that if I have provided incorrect or misleading information, or have omitted information of significance I may be disqualified from becoming a Volunteer, or if appointed, be liable to be dismissed.
Signed
Date
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