Volunteer Application

Previous association with St John Ambulance
Have you previously been associated with St John Ambulance? *

Yes No
State *
Branch *
Years of Service *
Grade in the Most Venerable Order of the Hospital of St. John of Jerusalem *
Last Role or Clinical Accreditation *
Capacity of Association *

Paid / Employed Volunteer

Drivers Licence
Do you hold a current Drivers Licence? *

Yes No
Licence Number *
Issuing State *
Class Code *
Expiry Date *

Day Month Year
Years Held *
Licence Transmission *

Automatic Manual
Do you have and Restrictions or Conditions on your Drivers Licence? *

Yes No
If yes, please provide details *

Vehicle Declaration

Please answer the following questions in relation to your vehicle for Community Care Shopping
Vehicle Make *
Vehicle Model *
Year of Manufacture *
Vehicle Registration Number *
Registration Expiry Date *

Day Month Year
Date
I …………………… declare that the vehicle I described above is registered and meets the regulations of Transport Tasmania in regards to roadworthiness whilst performing my duties as a St John Ambulance Community Care Volunteer and if my circumstances change regarding my licence and/or vehicle registration, I will notify St John Ambulance Australia (Tasmania) Inc.
Name *
Signature *

Clear
Date *

Day Month Year

Previous Volunteer Involvement

You can provide up to three (3) Organisations.
Add Previous Volunteer Involvement?

Yes No
Orginisation *
Year Started *
Year Finished *
Please leave blank if not required
Roles, Tasks or Duties *
Add another Organisation? *

Yes No
Organisation *
Year Started *
Year Finished *
Please leave blank if not required
Roles, Tasks & Duties *
Add another Organisation? *

Yes No
Organisation *
Year Started *
Year Finished *
Please leave blank if not required
Roles, Tasks & Duties *

Disclosures
Are there any Court Orders, Parenting Plans, Legal Guardianship, Restricted Access or related information regarding the applicant? If yes, please attached a copy. *

Yes No
File Upload *

Cancel of

Previous Education and Training (Health & First Aid)

You can provide up to three (3) Courses or Certificates
Add Previous Education and Training?

Yes No
Course or Certificate *
Year Started *
Year Finished *
Please leave blank if not required
Organisation, School or Institution *
Add another Course/ Certificate? *

Yes No
Course or Certificate *
Year Started *
Year Finished *
Please leave blank if not required
Organisation, School or Institution *
Add another Course/ Certificate? *

Yes No
Course or Certificate *
Year Started *
Year Finished *
Organisation, School or Institution *

Medical History
Do you have any Medical Conditions you wish to disclose? *

Yes No
If yes, please provide details *
Do you have any Allergies? *

Yes No
If yes, please provide details *

Parental/ Guardian Consent
1. I give consent for my child to register as a volunteer with St John Ambulance Australia and for my child to be trained in First Aid to the best of their ability.
2. I give consent for my child, when over the age of 14 years, to be taught Cardiopulmonary Resuscitation (CPR). *

Yes No
3. I consent to my child being photographed and the photos being used when required for official St John purposes. *

Yes No
4. I agree to inform St John Ambulance (Tas) office if any infomration on this form changes.

5. I will do all in my power to assiat my child to live up to their obligations.

6. Should my child require immediate first aid or medical care, I agree to St John imitating such required care, whist efforts are made to contact one of the emergency cointacts on this form.
Parental/ Guardian Name *
Parental/ Guardian Signature *

Clear
Date *

Day Month Year

Youth Member Code of Behavior
1. Cadets shall show respect to their peers and to all other members of St John.

2. Cadets shall always show courtesy towards all members of the public.

3. Cadets shall be responsible for their actions and will always act in a responsible and honest manner. This includes ensuring that their actions are neither offensive nor rude to others.

4. Cadets, when in uniform, or when involved in St John organised activities, shall behave in a manner that acknowledges and reflects the good reputation of St. John.

5. Cadets shall ensure that their uniform is worn in a respectable manner and always looks neat and tidy. Cadets should actively participate in age-appropriate cadet activities and ensure that everyone receives an equal opportunity to participate.

6. Fighting, offensive language or any type of unsociable behaviour will not be tolerated.

7. Under no circumstances are cadets allowed to consume alcohol, smoke cigarettes or take any illegal substance whilst participating in St John activities.

8. Where there is an issue that may involve unacceptable behaviour, like harassment or bullying, it is every member's responsibility to recognise and report it to the appropriate person in charge (the nearest adult).

9. Agree to follow St John policies and procedures, including those specifically relating to appropriate use of Social Media and Confidentially.
Youth Members Name *
Youth Members Signature *

Clear
Date *

Day Month Year

Declaration
Please read this section carefully to ensure you understand the conditions and requirements of St John Ambulance Australia (Tasmania) Inc:

I, the undersigned, make application for registration as a volunteer of St John Ambulance Australia (Tasmania) Inc and in so doing make the following declaration:
- That I understand that information about myself given in the course of my registration as a volunteer will be kept confidential and not disclosed to anyone not authorised to know that information.
- That should I be successful in my application for registration as a volunteer, I agree at all times to abide by the policies, procedures and regulations of St John Ambulance Australia (Tasmania) Inc, as defined and amended from time to time. I understand that St John Ambulance Australia is subject to Federal and State legislation regarding Discrimination, Harassment, Child Protection and Privacy and I must act in accordance with this legislation. I understand that St John Ambulance Australia is a provider of equal employment opportunities.
- I will uphold the St John Ambulance “Code of Conduct” in the spirit of the St John motto ‘Pro Fide’ (for the faith) and ‘Pro Utilitate Hominum’ (for the service of humankind) and endeavour to protect and enhance the good name of the organisation.
- I understand my obligation to continually update my skills including annual child protection training so that the professional image of St John Ambulance Australia may be enhanced. I understand my obligations in presenting the best possible image of St John Ambulance Australia to the public and that I grant permission for St John Ambulance Australia to use my image for publicity and communication purpose.
- I will advise St John Ambulance Australia of any physical or medical condition that could hinder my satisfactorily completing tasks that may be required as part of my work as a volunteer and that I have sufficient reading and writing ability to be able to satisfactorily complete tasks that involve the use of such ability. I will also notify St John Ambulance Australia immediately of my change of circumstance: e.g.; in ability to drive a motor vehicle in the case of suspension or loss of driver’s license.
- That I understand I am only covered by public liability and personal accident insurance whilst I am working within the direction of St John Ambulance Australia (Tasmania) Inc.
- I declare that all the information I have supplied in this application is true and correct and understand that any false declarations made above will invalidate my application. I further understand that my application is subject to an automatic annual National Police Check for which I consent, a probationary period, and acceptance as a volunteer will not be confirmed until the completion of all approval processes.
The information on this form is being collected by St John Ambulance Australia (Tasmania) Inc for the purpose of assessing your application for registration as a volunteer and may be considered in future applications or whilst conducting ongoing operations. The information on this form will be disclosed to relevant staff and managers at our State Office. You can access this information by contacting our Privacy Officer at our State Office in Moonah, phone: (03) 6271 0333. If you do not provide information requested your application may not be considered. If you withdraw your application at any time the information will be destroyed.
Applicant's Name *
Applicant's Signature *

Clear
Date *

Day Month Year

Required Information Upload
Do you hold a Current Working With Vulnerable People Card? *

Yes No
File Upload *

Cancel of
Do you hold a Current Police Check? *

Yes No
File Upload *

Cancel of

Privacy Statement
St John Ambulance (TAS) Inc respects the privacy of your personal information and is committed to treating it appropriately.

St John Ambulance (TAS) Inc will not, without your consent, use or disclose any such information it holds about you other than for the primary purpose it was collected, or another purpose for which you would normally expect it to be used.

St John Ambulance (TAS) Inc will take reasonable steps to ensure that any personal, health or sensitive information held if kept secure and protected from misuses, loss, unauthorised access, modifications and disclosure.
Please verify that you are human *
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Volunteer Application Form

Volunteering Opportunities

Personal Details

Previous association with St John Ambulance

Emergency Contacts

Drivers Licence

Vehicle Declaration

Previous Volunteer Involvement

Disclosures

Previous Education and Training (Health & First Aid)

Medical History

Fitness Ability (Would you be able to undertake the following?)

Parental/ Guardian Consent

Youth Member Code of Behavior

Declaration

Required Information Upload

Privacy Statement