Aged Care Volunteer Visitors Scheme Application Form

Thank you for your interest in the Aged Care Volunteer Visitors Scheme (ACVVS).

For more information on the role of an Aged Care Volunteer Visitor please visit the SVSA website. 

If you would like to explore becoming an Aged Care Volunteer Visitor, please complete our online application below. Once we receive your information we will be in touch to arrange to catch up and discuss the Aged Care Volunteer Visitors Scheme (ACVVS) in more detail.
 
We will also provide information on how to apply for your Criminal History Background Check. Background checks are mandatory for anyone working or volunteering with vulnerable people. Having a previous conviction may not necessarily preclude you from becoming a volunteer with the scheme. We are happy to discuss this further when we catch up.

Thank you again for your interest, we look forward to meeting you soon!
 
Privacy statement
Southern Volunteering strives to act with the highest integrity and offer the best possible services to volunteers, organisations and other people who access our services. To provide the highest standard of service to all its stakeholders, from time to time Southern Volunteering needs to collect personal information. Such information entrusted to Southern Volunteering is treated with the appropriate degree of privacy. Personal information is any information that an individual’s identity can be reasonably determined from. Southern Volunteering’s privacy policy and procedures are reviewed in accordance with changes in the law. Volunteer personal information will be held in a secure area for 7 years and then confidentially destroyed.

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* 1. Full Name

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* 2. Preferred Name

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* 3. Address

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* 4. Contact Telephone Number(s)

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* 5. Email Address
This will be used for correspondence with your ACVVS coordinator, as well as for receiving the ACVVS newsletter, and any relevant news, training or other opportunities.

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* 6. Date of Birth

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* 7. Country of Birth

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* 8. Additional Languages Spoken
*We ask this as some of our care recipients request a visitor that speaks a language other than English

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* 9. Gender

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* 10. Occupational Group (Optional)

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* 11. Religion (Optional)
*We ask this as some of our care recipients prefer a visitor that they can discuss their faith and beliefs with

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* 12. Will you be able to visit a resident at least once a fortnight?

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* 13. Do you understand you will have to undergo a police check?
*Please note that an existing criminal conviction will not necessarily bar you from becoming a Volunteer Visitor

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* 14. Do you have a drivers licence?
*This is not a requirement however you will be required to find your own transport to and from volunteering, some travel reimbursements are available. 

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* 15. Do you have access to a car?
*This is not a requirement however you will be required to find your own transport to and from volunteering, some travel reimbursements are available.

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* 16. Do you have any health limitations for volunteering?

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* 17. Please detail any other special requirements you may have that will enable volunteering with the Aged Care Volunteer Visitors Scheme to be a positive experience for you

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* 18. When visiting an older person, would you like to visit someone living in a Residential Aged Care Facility (RACF) or living at Home? (Please select one option only)

If no preference, or would like to do both, please use the comment section to explain.

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* 19. When visiting an older person, if the person you are visiting is able to do so, would you consider taking them out, or prefer to stay at the RACF or their home only? Tick as appropriate.

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* 20. Resident match preferred

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* 21. Availability (please tick all that apply)

  Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Morning
Afternoon

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* 22. Preferred Suburbs to Volunteer (please list any/all that are suitable)

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* 23. Please list your interests and hobbies (past and present) as well as any life experiences you believe are relevant to the role.
*Please provide as much detail as possible, as this is very useful when matching you with an older person. 

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* 24. What are the reasons you are wanting to volunteer?
Please briefly state why you wish to become an ACVVS Volunteer Visitor.

(This will help us when finding a possible match)

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* 25. Please provide the names and addresses of two referees and their relationship to you:
*Referees do not have to be from a work situation, just need a good knowledge of your character. Family members cannot be referees. Please ask your nominated referees for permission to provide their name and contact details before submitting this application form

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* 26. Please provide the name and contact details of an emergency contact 

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* 27. Special dietary requirements (for catering at ACVVS meetings)

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* 28. Please tick to sign the form and verify that the information provided is correct.

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* 29. Please tick the box below to agree that your contact details can be provided to Aged Care Facilities where you will be visiting a resident/Home Care Package Provider, as a participant in the Aged Care Volunteer Visitors Scheme.

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