Community Visitors Scheme Application Form

Thank you for your enquiry regarding the Community Visitors Scheme.

For more information on the role of a Community Visitor please visit

If you would still like to explore becoming a CVS volunteer, then please answer the questions that follow. This is our online application form and in order for it to be processed you need to work through all the questions until you reach the last page. Once I receive your application form I will contact you and invite you in to our office to discuss the CVS program in more detail and give you the chance to ask any questions you may have. During that meeting I will also arrange for a Criminal History Background check which is mandatory for anyone working or volunteering with vulnerable people. Having a previous conviction will not necessarily bar you from becoming a volunteer with the scheme. Again I can discuss that further at our meeting.
Thank you for your interest, I 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 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.

* 1. Full Name

* 2. Preferred name

* 3. Address

* 4. Contact telephone number(s)

* 5. Email address

* 6. Date of Birth

* 7. Gender

* 8. Occupational Group

* 9. Birth Country

* 10. Additional languages spoken

* 11. Religion

* 12. How did you hear about the Community Visitors Scheme?

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

* 14. Do you have a drivers licence?

* 15. Do you have access to a car?

* 16. Do you understand you will have to undergo a police check? (please note: an existing criminal conviction will not necessarily bar you from becoming a CVS volunteer)

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

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

* 19. Would you like to attend training sessions and volunteer meetings? (please note: attendance at training and volunteer meetings is not compulsory)

* 20. Resident match preferred

* 21. Availability (please tick all that apply)

  Monday Tuesday Wednesday Thursday Friday Saturday Sunday

* 22. Aged Care Facility Preferred (please tick all that are suitable)

* 23. Reasons for volunteering. Please briefly state why you wish to become a Community Visitor.

* 24. Experience. Please describe any experience you may have in supporting older people and/or any experience in hostels or aged care facilities (not essential)

* 25. Interests. Please list your interests and hobbies (past and present)

* 26. Life experiences / background. Please identify any particular life experiences (e.g. travel, occupations, where you have lived)

* 27. Please provide the names and addresses of two referees and their relationship to you. Please note, family members cannot be referees. In addition please ask your nominated referees for permission to provide their name and address before submitting this application form

* 28. Special dietary requirements (for catering at CVS meetings)

* 29. Please tick to sign the form

* 30. 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 as a participant in the Community Visitors Scheme