SUPPORT STAFF EMPLOYMENT APPLICATION FORM

COVID-19

REGISTRATION

To enable you to work or volunteer when students are present, you are required to provide evidence of your vaccination. Use the guide below to upload confirmation of your vaccine status. Please complete this as soon as possible.

Personal Details

Official First Name*

Official Surname*

Date*

Date

Reason for completing this form?*

Are you a BC Parent or Caregiver*

Name of child *

Type student's name or 'none' if not applicable

Contact Details

Email address*

example@example.com

Landline Phone number

Mobile Phone number*

Home Address*

Street Address

Street Address Line 2

SuburbTown/City

Postcode

Vaccination Details

1st Vaccination

Have you received your 1st COVID-19 vaccination?*

Date of 1st Vaccination*

Date

Vaccination Brand*

2nd Vaccination

Have you received your 2nd COVID-19 vaccination?*

Date of 2nd Vaccination

Date

Vaccination Brand

Booster Vaccination

Have you received your 3rd COVID-19 vaccination/Booster?*

Vaccination Brand

COVID-19 Vaccination Comments*

Please enter any additional information relating to your COVID-19 vaccination. If you have not yet had your 2nd vaccination, please state the date you expect to have it.

Yes

Vaccination Documents

Please access your ‘MyCovidRecord’ via this link and upload the screenshot to this form. This is the ONLY form of proof we can accept. We CANNOT accept your Vaccine pass or Vaccination appointmentcard. These will not be accepted and you will be required to fill outthis form again. Thank you for complying with this MOE requirement.

Upload your MyCovidRecord Screenshot:*

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