APPLICATION FORM

APPLICATION FORM

STAFF, LEADER AND VOLUNTEER
Name

First NameLast Name
Address
Phone
Email
example@example.com
Are you aged 18 years or over?

YesNo
Do you have a current Working with Children Check?*

YesNo
If no, are you willing to obtain one?*

YesNo
Do you have a current Police Check?*

YesNo
If no, are you willing to obtain one?*

YesNo
FAITH COMMUNITY PROGRAM EXPERIENCE
Have you attended WVC for over 6-months?*

YesNo
How long have you been attending WVC?
How are you currently involved in the life of WVC?
Please describe any Faith Community groups you have previously been involved in (within this community, other communities, schools ministries, etc
Please indicate any previous training and / or qualifications you have that are relevant.
If required are you willing to undertake specific training for this role?*

YesNo
Do you have a current First Aid certificate?*

YesNo
If yes, what level?
Critical Overview
Have you ever had any child related work (paid or voluntary) refused or suspended?*

YesNo
Have you ever had any allegations of misconduct from the following?- Bullying / harassment- Child abuse- Sexual assault- Violence / aggression*

YesNo
Have you ever been convicted of or charged with a criminal offence?*

YesNo
Have you ever had a child or young person removed from your care for any reason?*

YesNo
Have you ever experienced substance abuse - misuse of alcohol/recreational/illegal drugs; or prescription / over-the-counter medication? (or any other kind of substance)*

YesNo
Have you ever had your driver's license suspended or disqualified?*

YesNo
If you answered "yes" to any of the questions in this table please provide further information:
What qualities and/or leadership characteristics do you believe you are able to bring to this role?
Details of Two Referees

Preferably people who have known you for five or more years.
Name of Referee
Phone Number
Email
example@example.com
What is their usual occupation?
How long has the referee known you?
What is their relationship to you, the applicant?
Any Comments
Name of Referee 2
Phone Number
Email
example@example.com
What is their usual occupation?
How long has the referee known you?
What is their relationship to you, the applicant?
Any Comments
Declaration
I declare that all information contained in this ‘WVC Staff, Leader and Volunteer Application Form’ is correct, true and complete and I have provided all information to the best of my knowledge.

I understand omitting information and / or providing false information is sufficient cause for my application to cease.

I Agree and Commit to the Following:
- Adhere to the Code of Conduct
- Attend all required training
- Attend all required meetings
- Provide all relevant background checks
- Operate within best practices for the ministry
- Be unified within the leadership team
Name of Worker
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

APPLICATION FORM

FAITH COMMUNITY PROGRAM EXPERIENCE

Critical Overview

Details of Two Referees

Declaration