Volunteer Application Form - Confidential: Your Personal Details

Volunteer application form – confidential
Thank you for considering becoming a volunteer for the Department for Education and Child
Development (DECD). Please complete and return this form to the School of Languages.
Are you a parent/guardian of a child at the School of Languages? No Yes
Given and Family Name of your child: __________________________________________________
 If you are a parent or guardian of the child, in whose class you will be volunteering, you do not
require a DCSI child related employment screening.
 If you are a family member of the student (ie aunt, uncle, grandparent) then you require a DCSI
child related employment screening. (available at:
http://www.dcsi.sa.gov.au/services/screening/submitting-your-application-and-payment)
 All volunteers must complete Responding to Abuse and Neglect training. (The
https://www.plink.sa.edu.au/pages/signup.jsf takes about 90 minutes and includes an
assessment.)
I would like to work as a volunteer in the _________________________ (language) class
at _____________________________ (teaching centre)
with ___________________________ (teacher).
Your personal details

Are you a parent or guardian of a child at this location? Yes No
Given name: Preferred name for

name badge:
Family name:
Home address: Date of birth:
Female / male /
gender of choice:
Postal address: Home phone:
Same as above
Mobile:
Email address:
Emergency Emergency
contact name: contact phone:
Do you have any psychological or medical conditions that might affect your ability to volunteer? Or
anything we need to know in case of an emergency?
1| Volunteer application form and declaration | June 2018

For example: diabetes, severe food allergy, asthma, epilepsy Yes No
(If yes please give details below and discuss at your interview.)
Do you need any special assistance because of a disability? Yes No
(If yes please give details below and discuss at your interview.)
Your volunteering, employment or study details

Tell us about something you’ve done recently
Name of organisation:
Organisation phone:
How can you connect with our community?

Your country of birth:
Are you of Aboriginal and/or Torres Strait
Yes No Not stated
Islander origin?
Languages you speak other than English:
Availability:
What days and times do you think you could
volunteer?
Tell us about yourself:
List a few things that you can contribute to your role
as a volunteer. For example, mentoring, gardening,
storytelling, administration, sport and so on.
Screening
Volunteering with us might mean that you need a relevant history screening.
You understand that if a screening is needed you will not be able to start
volunteering until a clearance has been received.
Yes No
Your personal referees

We will contact these people to find out a bit more about you. It’s okay if it’s someone at our site who
already knows you. We just need at least one person’s details.
2 | Volunteer application form and declaration | June 2018

Referee 1
Name: Email or phone:
How do you know this person?

friend relative employer volunteer coordinator
other (please specify):
Referee 2
Name: Email or phone:
How do you know this person?

friend relative employer volunteer coordinator
other (please specify):
Volunteer declaration – confidential

To make sure we meet our commitment to child safety, we need this information and declaration from you.
If you have any questions about this declaration, you can talk to a site leader about it.
Have you ever been investigated, arrested, reported for or pleaded or found
guilty of any criminal offence including any traffic offences (not including Yes No
parking infringements)?
Have you ever been dismissed or resigned from any employment or a

volunteer role in response to or following allegations of improper conduct Yes No
relating to children?
Have you ever been the subject of allegations or an investigation or any

other process relating to alleged misconduct by you as a volunteer or an Yes No
employee?
Have you ever been the subject of allegations of inappropriate conduct of a

Yes No
violent or sexual nature towards or in relation to anyone?
Have you ever been refused a child related employment screening or

working with children check in South Australia or in another Australian Yes No
jurisdiction?
You understand that if the information in this application or declaration

changes, it is your responsibility to advise the DECD site leader as soon as Yes No
possible.

Note: If you answered ‘yes’ to any of the above questions, you might be asked for more
details, including any relevant documentation, before you can be placed as a volunteer.
I confirm and declare that to the best of my knowledge I have truthfully answered all questions.
I understand that if I provide any false or misleading information I cannot start or stay on as a
volunteer.
Your signature: ________________________ Date: __________________ (day/month/year)
Please forward this completed form (all three pages) to the School of Languages and arrange for
an interview with the Assistant Principal: Student and Staff Services.
Next steps:
 Have an interview
 Complete a Relevant History Screening when required
 Reference Checks done by School of Languages
 Complete online Responding to Abuse and Neglect-Education and Care Induction for Volunteers
 Be provided with a Role Description
 Complete online general induction at the site
 Complete induction at the site
 Sign a volunteer agreement signed with the Assistant Principal
Commence volunteer role once approved by the Assistant Principal
For further information about Volunteering contact

the School of Languages.
The information you provide will be treated sensitively and confidentiality according to the State
Records Act 1997 and the Information Privacy Principles Instruction.
_______________________________________________________________________________________________
OFFICE USE ONLY

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Volunteer application form – confidential

Are you a parent/guardian of a child at the School of Languages? No Yes

Given and Family Name of your child: __________________________________________________

I would like to work as a volunteer in the _________________________ (language) class

at _____________________________ (teaching centre)

with ___________________________ (teacher).

Your personal details

Given name: Preferred name for

1| Volunteer application form and declaration | June 2018

Do you need any special assistance because of a disability? Yes No

Your volunteering, employment or study details

How can you connect with our community?

Your personal referees

2 | Volunteer application form and declaration | June 2018

How do you know this person?

How do you know this person?

Volunteer declaration – confidential

Have you ever been dismissed or resigned from any employment or a

Have you ever been the subject of allegations or an investigation or any

Have you ever been the subject of allegations of inappropriate conduct of a

Have you ever been refused a child related employment screening or

You understand that if the information in this application or declaration

3 | Volunteer application form and declaration | June 2018

Commence volunteer role once approved by the Assistant Principal

For further information about Volunteering contact

OFFICE USE ONLY

4 | Volunteer application form and declaration | June 2018

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