Volunteer Application Form

Applicant Information

First Name

Last Name

Preferred Name

Address

Contact Phone Number

Preferred method of communication

Txt MessageEmailPhone Call

Preferred option for receiving Rosters

EmailPost

Emergency Contact

Contact Name

Relationship

Postal Address

Phone

Email:

When are you available?

Please indicate what days and times you are available.

Ho often are you available?

DailyWeeklyFortnightlyMonthlyEmergency

Which day/s are you available?

MonTueWedThurFriSatSun

Which volunteering program are you interested in?

You may choose from Community Care or Homestead or both.

Community Care: Social Connections Program Meals on Wheels Program Friendly Visiting ProgramWestmont Homestead: Social Connections Program Friendly Visiting Program

Referees

Please provide contact details for two referees. Westmont will contact your referees to gain a character reference beforeyou commence volunteer work with Westmont Community Care.

Referee 1 *

Mobile 1 *

Referee 2

Mobile 2 *

Completed Police Check at https://crimecheckaustralia.com.au/apply/?gad=1&gclid=Cj0KCQjwoK2mBhDzARIsADGbjeo0lud6RSorC3ZpG_uWxFJatBD0k4rXzNuoGqalfGNQQ6-Vy-8sUzwaAi6-EALw_wcB

Yes

Upload a copy of your annual influenza vaccination record *

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Upload and at least two COVID immunisation record:s. *

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Upload a copy of your photo ID here: *

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Volunteer Declaration

I agree to abide by the policies and procedures of both Westmont Community Care Services and individual business unitsand I agree to work within boundaries of the job and to respect confidentiality.

Signature

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Date

Parent/Guardian Permission

To be completed if applicant is less than 18 years of age.

Parent/Guardian Name

Parent Guardian Phone

Parent/Guardian Signature

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Date Signed

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Updated: June 2022 N:\Community Care Files\C.C. Numbering system ALL forms and documents\Forms\Website Forms\Community Care Volunteer ApplicationForm_v2.0_Online Version_Auto Submit.docx