Loneliness Warrior - Volunteer Application Form Personal information is collected for Loneliness Warriors Program purposes only, including for your health and safety. All personal information is kept in accordance with Privacy Legislation and is not used for any other purpose without your consent. Question Title * 1. Applicant Information Full Name Date of Birth Address Phone Number Mobile Number Email Question Title * 2. Do you speak a language other than English? Please list all languages spoken below. No Yes (please specify) Question Title * 3. How would you rate your English language skills? Low - only a few words Ok Good Great Fluent Low - only a few words Ok Good Great Fluent Other (please specify) Question Title * 4. Tell us why you would be a great Loneliness Warrior? Question Title * 5. Please list previous relevant volunteer/employment/training history: Question Title * 6. Please list any known health issues below: Question Title * 7. Are you comfortable working with people from different social and cultural backgrounds? Yes No Comment Question Title * 8. Are you happy to commit to being a Loneliness Warrior volunteer until at least 30 May 2022? Yes No Comment Question Title * 9. Is there anything that may hinder your availability or capacity to volunteer with the Loneliness Warrior program? Question Title * 10. Do you have a current National Police check or any DHS/DCSI clearances? *Please list name, reference numbers and expiry date for each Name, Reference Number, Expiry Name, Reference Number, Expiry Name, Reference Number, Expiry Name, Reference Number, Expiry Name, Reference Number, Expiry Applicant availabilityThe Loneliness Warrior Program operates between the hours of 9.30am - 5pm five days a week. Question Title * 11. Please provide your availability to volunteer Monday Tuesday Wednesday Thursday Friday Morning (9:30am - 1:00pm) Morning (9:30am - 1:00pm) Monday Morning (9:30am - 1:00pm) Tuesday Morning (9:30am - 1:00pm) Wednesday Morning (9:30am - 1:00pm) Thursday Morning (9:30am - 1:00pm) Friday Afternoon (1:00pm - 5:00pm) Afternoon (1:00pm - 5:00pm) Monday Afternoon (1:00pm - 5:00pm) Tuesday Afternoon (1:00pm - 5:00pm) Wednesday Afternoon (1:00pm - 5:00pm) Thursday Afternoon (1:00pm - 5:00pm) Friday Other (please specify) Question Title * 12. Is there anything else you would like us to know or consider when processing your application? Applicant AgreementI understand that if I successfully become a volunteer mentor in the Loneliness Warrior Program I will be held accountable to Program expectations.I, the participant (applicant), agree to: All necessary checks and clearances being carried out against my background, including a National Police Check, Working with Vulnerable Persons Check Undertake all training and induction processes for the Loneliness Warrior program including volunteer induction at Community Centres SA Conduct myself in a responsible, respectful and appropriate manner at all times I, the participant (applicant), acknowledge that: I am expected to give a minimum of 24 hours’ notice if I am unable to attend a supervision mentor session I must successfully gain all DHS, and National Police clearances to be accepted as a LW If I do not complete mandatory training I will be unable to participate as a volunteer in the Loneliness Warrior program Question Title * 13. If you acknowledge and agree to the Applicant Agreement as stated above please select: Yes, I acknowledge and agree to the Applicant Aggreement No, I do not acknowledge and agree to the Applicant Agreement Done