Volunteer FormFor all new volunteers. Date MM DD YYYY Name * First Name Last Name Email Phone (###) ### #### Have you been attending Burnie City Church for 12 or more months? Yes No If 'no' please add reference of workplace and/or previous church Emergency Contact * First Name Last Name Emergency Contact Phone (###) ### #### Has anyone ever brought or threatened to bring civil or crimininal claim against you alleging physical or sexual abuse or sexual harassment? Yes No Have you had employment terminated for above reason? Yes No Are there any medical conditions, relevant information or limitations (eg. back injury, epilepsy) that could affect your ability to volunteer? Yes No If 'yes' please provide details Do you have current Tasmanian WWVP? Yes No I have applied Do you have current first aid training? Yes No Please list any current/relevant training/qualifications I agree to support and act in accordance with Burnie City Church's vision and values and to abide by their policies and procedures. I agree that the information given in this application is complete and accurate, not misleading in any way. Yes No Which department are you hoping to volunteer with? Have you been interviewed, questioned or charged by police in relation to any offences (violence, alcohol or drugs) involving children and/or youth? Yes No Have you been convicted of any offences involving children, youth, alcohol or drugs? Yes No Do you have children (under 18) that have been removed from your care? Yes No Please write you full name and date in lieu of signature Parent/guardian (if under 18) First Name Last Name Name First Name Last Name Phone (parent/guardian) (###) ### #### Thank you!
