Community Awareness Application Form

Community Awareness Presenter Application Form

Fill out the form carefully for registration
Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Gender*

Work Availability*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address*
example@example.com
Mobile Number*
Region interested in Community Awareness (Please specify regions that are close to where you reside)*

BrisbaneGold CoastSunshine CoastWide BayNorth BarrierNorth Queensland
Do you hold any current qualifications?*

Bronze MedallionFirst AidSRC (Surf Rescue Certificate)Drivers LicenseWorking with Children blue card
What surf club were / are you apart of?*
Do you have any relevant experience?*
Additional information
Reference Checks

Please provide 2 referees SLSQ have permission to contact
Referee 1*

First NameLast Name
Email*
example@example.com
Relationship to you*
Referee 2*

First NameLast Name
Email*
example@example.com
Relationship to you*
Please provide 2 employment / character references with name, position and phone number.*
Resume and other documentation *

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Community Awareness Presenter Application Form