Volunteer Interest Form

If you would like to volunteer with Missionheart please complete the following form and we will be in contact with you.

Name *

First

Last

Address *

Best Contact Number *

Email *

What sort of paid employment have you had, or do you currently do (please list names of employers and roles taken)? *

What church do you attend? How long have you been there? What roles do you do there? *

What skills do you have that may be relevant to a volunteer role at Missionheart? *

What ministry would you like to assist in? *

Do you have a current first aid certificate? *

Yes
No

Please provide 2 referees and include their contact details? *

(Please answer the following questions with a yes or no. If you answer yes to any of the questions please provide additional information below.) Do you have any health problem(s) which may affect you volunteering for Missionheart? *

Yes
No

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

Yes
No

As an adult (18+ years) have you ever engaged in, even though never having been charged: sexual contact with someone under your care other than your spouse (such as a client, patient, student, employee or subordinate)? *

Yes
No

As an adult (18+ years) have you ever engaged in, even though never having been charged: sexual contact with a person under the age of consent? *

Yes
No

As an adult (18+ years) have you ever engaged in, even though never having been charged: sexual abuse (this includes sexual harassment, acts of indecency, non contact and/or contact sexual abuse)? *

Yes
No

As an adult (18+ years) have you ever engaged in, even though never having been charged: illegal use, production, sale or distribution of pornographic materials? *

Yes
No

As an adult (18+ years) have you ever engaged in, even though never having been charged: conduct likely to cause sexual harm to people, or to put them at risk of harm? *

Yes
No

To your knowledge, have you ever been the subject of an allegation of sexual abuse or sexual misconduct? *

Yes
No

Have you ever done anything in the past or present that may result in allegations being made against you of bullying, emotional abuse, harassment, or physical abuse against a child or an adult? *

Yes
No

Have you ever had an apprehended violence order, order for protection or the like issued against you as a result of allegations of violence, abuse, likely harm, harassment, stalking, etc.? *

Yes
No

Have you ever had permission to undertake paid or voluntary work with children or other people refused, suspended or withdrawn in Australia or any other country? *

Yes
No

Has a child or dependent young person in your care (as a parent or in any other capacity) ever been removed from your care, or been the subject of a risk assessment by the authorities? *

Yes
No

Has your driver's licence ever been revoked or suspended? *

Yes
No

Have you a history of alcohol abuse or a history of substance abuse including prescription, over the counter, recreational or illegal drugs? *

Yes
No

Please provide additional information below if you answered yes above

By submitting this form I declare that all information is accurate and a truthful representation of my skills, abilities and history. *

I agree

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