Community Visitors Scheme Application Form

Thank you for your interest in the Community Visitors Scheme.

For more information on the role of a Community Visitor please visit
https://svsa.org.au/community-visitors-scheme/ or https://www.health.gov.au/initiatives-and-programs/community-visitors-scheme-cvs-0

If you would like to explore becoming a CVS volunteer, please complete our online application below.

Once we receive your information we will be in touch to arrange to catch up and discuss the CVS Program in more detail. We will also provide you with 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.

Please work through all 34 questions then press ‘Next’ to submit your Application.

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.

Question Title

* 1. Full Name

Question Title

* 2. Preferred name

Question Title

* 3. Contact telephone number(s)

Question Title

* 4. Email address

Question Title

* 5. Date of Birth

Question Title

* 6. Gender

Question Title

* 7. What suburb do you live in? Please state name of suburb and postcode.

Question Title

* 8. What is the name of your street and it's number?

Question Title

* 9. Occupational Group

Question Title

* 10. Birth Country

Question Title

* 11. Additional languages spoken

Question Title

* 12. Religion

Question Title

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

Question Title

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

Question Title

* 15. Do you have a drivers licence?

Question Title

* 16. Do you have access to a car?

Question Title

* 17. 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)

Question Title

* 18. Some Aged Care Facilities may still ask to see your Flu & COVID-19 Vaccination certificates. Are you willing to comply with this?

Question Title

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

Question Title

* 20. 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

Question Title

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

Question Title

* 22. Resident match preferred

Question Title

* 23. Availability (please tick all that apply)

  Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Morning
Afternoon

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

* 29. 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

Question Title

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

Question Title

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

Question Title

* 32. Please tick to sign the form

Question Title

* 33. 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

T