Skip to content
Expression of Interest for Volunteer Visitor
*
ABOUT YOU:
(Required.)
Full Name:
Preferred name:
Gender:
Address:
Suburb & Postcode:
Date of birth (dd/mm/yyyy):
Phone:
Email:
Country of Origin:
Have you lived outside of Australia for more than 12 months after the age of 16? Yes/No:
Are you an Australia citizen? If no, which visa type:
*
Information to help us match you with a senior
(Required.)
Do you speak languages (including dialects) other than English? If so, please list:
What have been/are your major areas of education/training?
Indicate previous / current work:
Indicate any previous volunteering experience:
Indicate any previous experience in aged care, including as a family carer:
Do you have other personal or hobbies to share with an older person?
Is there any information, medical or otherwise, that you feel we need to be aware of that may affect your volunteering?
Yes
No
If Yes (please specify)
AVAILABILITY
*
Do you have sufficient time to visit a minimum of once a fortnight (10 visits minimum over a 6- month period). Please indicate your availability:
(Required.)
AM
PM
MONDAY
AM
PM
TUESDAY
AM
PM
WEDNESDAY
AM
PM
THURSDAY
AM
PM
FRIDAY
AM
PM
SATURDAY
AM
PM
SUNDAY
AM
PM
Specific Times (if any)
EMERGENCY CONTACT INFORMATION
*
EMERGENCY CONTACTS:
(Required.)
Name:
Relationship:
Phone No:
Name:
Relationship:
Phone No:
REFEREES
*
Please provide details of two referees who you have contacted and who have agreed to be your referee when we call.
(Required.)
Name:
Address:
Relationship:
Phone:
Name:
Address:
Relationship:
Phone:
Additional
*
How did you hear about us?
(Required.)
AfCAS Facebook
AfCAS LinkenIn
AfCAS Website
Other (please specify)
Privacy Information Consent:
I consent to AFCAS collecting personal information about me.
I understand that the collection of this information is required for use in the aged care volunteer visitors scheme.
200%
