Volunteer in an Emergency

Your details

Do you agree to have your information stored in our database?*

Yes
No

Your information will be stored confidentially on our agency database and used for provision of service and may also be used for research. Your name and details will not be included in reporting.

Preferred Pronouns

He/Him
She/Her
They/Them

Please use the comment box option if you prefer to self-describe.

First name*

Last name*

Date of birth*

Gender*

Female
Male
Non-binary/Gender diverse

Please use the comment box option if you prefer to self-describe.

Contact details

Street address

Suburb*

Phone (mobile/home)*

Email

Culture, language and identity

Country of birth*

Please use the comment box option if your country of birth is not listed.

Main language spoken at home*

Please use the comment box option if your main language spoken at home is not listed.

Other languages you speak

Level of spoken English

Beginner
Intermediate
Fluent

Do you identify as Aboriginal or Torres Strait Islander?*

No
Aboriginal
Torres Strait Islander
Aboriginal and Torres Strait Islander
Prefer not to say

Do you identify as having a disability?

Yes
No
Prefer not to say

Residency status

Prefer not to say
Australian citizen
Permanent resident
Skilled migrant
International student

Please use the comment box option if your residency status is not listed.

Emergency contact information

Name of your emergency contact person*

Emergency contact number*

Relationship of emergency contact person

Experience, skills and abilities

How will you travel to your volunteer role?

Own car
Public transport
Other

Other way you will travel to your volunteer role*

What is your current work status?

Employed (full-time)
Employed (part-time)
Unemployed (not working but looking for work)
Unpaid work (including volunteering)

What is your current occupation?

Are you currently studying?

Yes
No

Are you interested in volunteering as part of a Centrelink obligation?

Yes
No

Volunteering interests and availability

What inspires you to want to volunteer?

Are you available for*

General / routine volunteering
Digital / online / phone volunteering
Project / short term volunteering
Special event volunteering
Emergency response volunteering

What service area would you like help in?*

Tick as many as you like

Other service area you would like help in*

Days and times you are available to volunteer*

How did you find out about our service?

Would you like to receive email updates about volunteer activities at Whittlesea Community Connections?*

Yes
No

Privacy Statement

I authorise Whittlesea Community Connections to release information to volunteer organisations in order to obtain a volunteer position and give consent to my details being entered into their database and a Federal Government DSS Data Exchange database to be used for statistical purposes and service evaluations. Also, I provide consent to be contacted in future for survey, research and evaluation purposes. Your name and details will not be included in reporting.

I agree to have my information stored*

Type your name

Date of agreement*