CBNZ Volunteer Application Form

Volunteer Application Form
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Email*
example@example.com
What position are you applying for?*
Area/s Of Interest*

Otara Kai VillageOtara Bike BurbOtara Mara KaiMy Street MovementThe Clover Park Community HouseCBNZ Events
Languages Spoken/ Written: *
Emergency Contact

Next of kin
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Email*
example@example.com
Relationship to Volunteer applicant:*
Skills

Experiences / Qualifications
Do you have any qualifications relevant to the position you are applying for?*
if yes please give details: *
Please describe any knowledge/ skills and experiences you possess which may be relevant to the position you are applying for: *
Health Issues
Do you have known health conditions, injuries or illnesses of any kind that may affect your ability to effectively carry out the functions and responsibilities of the position that you are applying for?*
If yes please give details:*
Are you on any medication that may affect your performance in the position that you are applying for? *
If yes please give details:*
Referees
Name Of Person*

First NameLast Name
Relationship to you*
Referee Phone Number*
Referee Email*
example@example.com
Drivers License
Do you hold a current full New Zealand's Driver License?*
What type of License do you have?*

LearnersRestrictedFullNone
Is there any matter pending which could affect the status of your Drivers License?*
General
Have you had any criminal convictions in the last 5 years?*
If yes, Please give details: *
Are you currently awaiting the hearing of any criminal charges?*
If yes, Please give details:*
Availability
If your application is successful, when are you able to start volunteering?*

MonthDayYear
Date
What days of the week are you available?*

MondayTuesdayWednesdayThursdayFridaySaturday
Are you available full day/ half day? Please specify*
Communication

How would you like us to contact you?
Shift details (please tick)*

textcallemailmessenger
Events and Happenings: (please tick)*

textcallemailmessenger
Transport
Please Select*

I have my own transportI would be able to offer volunteers without transport a rideI would need a contribution towards petrol costs to volunteer regularlyI do not have transportI would need assistance with transport to volunteer regularly
Volunteer Positions

Tell us what areas you are interested in volunteering
Please Select*

NavigatorOKV/OBB/OMKPataka KaiEvents/ fundraisingNo PreferanceOther
Do you have any experience in any of these areas or any other details to add? *
Declaration
Name*

First NameLast Name
By submitting this application, confirm that the information provided is true and complete.

I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.

I give permission for you to contact the referees listed above in order to determine my suitability for a Volunteer position with The Community Builders NZ Trust.

I give permission for a representative of The Community Builders NZ Trust to contact the referees named in the application for the purpose of determining my suitability for the position.

I understand that any positions that work directly with children or young people may require Policy Vetting.
Date*

MonthDayYear
Date
Signature*

Clear
Should be Empty:

Volunteer Application Form

Emergency Contact

Skills

Health Issues

Referees

Drivers License

General

Availability

Communication

Transport

Volunteer Positions

Declaration