Expression of Interest for Volunteer Visitor

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* 1. PERSONAL PARTICULARS:

Name:

Address:

Telephone Numbers:

Email:

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* 2. EMERGENCY CONTACT:

Name:

Relationship:

Phone No:

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* 3. DETAILS OF EDUCATION: i.e. High School Education, certificates, Diploma, Degrees, Training Period, Training Institution Type.

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* 4. Languages spoken:

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* 5. Ethnicity:

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* 6. Religion:

EXPERIENCE:

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* 7. Do you have volunteer experience?

Yes

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* 8. Name of Organization:

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* 9. Length of Service:

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* 10. Is there any information, medical or otherwise, that you feel we need to be aware of that may affect your volunteering?

Yes

If Yes (please specify)

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* 11. Why do you want to volunteer with AfCAS?

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* 12. What are the things you like to do and can do fairly well?

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* 13. What new things would you like to do, or have an interest in learning?

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* 14. What are the things you do not like to do and would be clearly off limits?

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* 15. Please explain what you expect as a volunteer with AfCAS.

AVAILABILITY

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* 16. Please specify the days you are available to volunteer.

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.