I am an RSL NSW member and wish to apply to volunteer with the SHINE for Kids Co-op Limited
RSL NSW Member Number:
RSL NSW sub-Branch Location:
Application Date *
Title
DR
MISS
MR
MRS
MS
First Name *
Last Name *
Gender *
Male
Female
Home Address *
City *
State *
Zipcode/Postcode *
Country *
-- Select Country --
AFGHANISTAN
ALAND ISLANDS
ALBANIA
ALGERIA
AMERICAN SAMOA
ANDORRA
ANGOLA
ANGUILLA
ANTARCTICA
ANTIGUA AND BARBUDA
ARGENTINA
ARMENIA
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AZERBAIJAN
BAHAMAS
BAHRAIN
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BELARUS
BELGIUM
BELIZE
BENIN
BERMUDA
BHUTAN
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BOTSWANA
BOUVET ISLAND
BRAZIL
BRITISH INDIAN OCEAN TERRITORY
BRUNEI DARUSSALAM
BULGARIA
BURKINA FASO
BURUNDI
CAMBODIA
CAMEROON
CANADA
CAPE VERDE
CAYMAN ISLANDS
CENTRAL AFRICAN REPUBLIC
CHAD
CHILE
CHINA
CHRISTMAS ISLAND
COCOS (KEELING) ISLANDS
COLOMBIA
COMOROS
CONGO
CONGO, THE DEMOCRATIC REPUBLIC OF THE
COOK ISLANDS
COSTA RICA
CÔTE D'IVOIRE
CROATIA
CUBA
CYPRUS
CZECH REPUBLIC
DENMARK
DJIBOUTI
DOMINICA
DOMINICAN REPUBLIC
ECUADOR
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ERITREA
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ETHIOPIA
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FAROE ISLANDS
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GRENADA
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HEARD ISLAND AND MCDONALD ISLANDS
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HONDURAS
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IRAN, ISLAMIC REPUBLIC OF
IRAQ
IRELAND
ISRAEL
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KENYA
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KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF
KOREA, REPUBLIC OF
KUWAIT
KYRGYZSTAN
LAO PEOPLE'S DEMOCRATIC REPUBLIC
LATVIA
LEBANON
LESOTHO
LIBERIA
LIBYAN ARAB JAMAHIRIYA
LIECHTENSTEIN
LITHUANIA
LUXEMBOURG
MACAO
MACEDONIA, THE FORMER YUGOSLAV REPUBLIC OF
MADAGASCAR
MALAWI
MALAYSIA
MALDIVES
MALI
MALTA
MARSHALL ISLANDS
MARTINIQUE
MAURITANIA
MAURITIUS
MAYOTTE
MEXICO
MICRONESIA, FEDERATED STATES OF
MOLDOVA, REPUBLIC OF
MONACO
MONGOLIA
MONTENEGRO
MONTSERRAT
MOROCCO
MOZAMBIQUE
MYANMAR
NAMIBIA
NAURU
NEPAL
NETHERLANDS
NETHERLANDS ANTILLES
NEW CALEDONIA
NEW ZEALAND
NICARAGUA
NIGER
NIGERIA
NIUE
NORFOLK ISLAND
NORTHERN MARIANA ISLANDS
NORWAY
OMAN
PAKISTAN
PALAU
PALESTINIAN TERRITORY, OCCUPIED
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
PITCAIRN
POLAND
PORTUGAL
PUERTO RICO
QATAR
REUNION
ROMANIA
RUSSIAN FEDERATION
RWANDA
SAINT BARTHÉLEMY
SAINT HELENA
SAINT KITTS AND NEVIS
SAINT LUCIA
SAINT MARTIN
SAINT PIERRE AND MIQUELON
SAINT VINCENT AND THE GRENADINES
SAMOA
SAN MARINO
SAO TOME AND PRINCIPE
SAUDI ARABIA
SENEGAL
SERBIA
SERBIA AND MONTENEGRO
SEYCHELLES
SIERRA LEONE
SINGAPORE
SLOVAKIA
SLOVENIA
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SOMALIA
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SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS
SPAIN
SRI LANKA
SUDAN
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SVALBARD AND JAN MAYEN
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SWEDEN
SWITZERLAND
SYRIAN ARAB REPUBLIC
TAIWAN
TAJIKISTAN
TANZANIA, UNITED REPUBLIC OF
THAILAND
TIMOR-LESTE
TOGO
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TONGA
TRINIDAD AND TOBAGO
TUNISIA
TURKEY
TURKMENISTAN
TURKS AND CAICOS ISLANDS
TUVALU
UGANDA
UKRAINE
UNITED ARAB EMIRATES
UNITED KINGDOM
UNITED STATES
UNITED STATES MINOR OUTLYING ISLANDS
URUGUAY
UZBEKISTAN
VANUATU
VENEZUELA
VIETNAM
VIRGIN ISLANDS, BRITISH
VIRGIN ISLANDS, U.S.
WALLIS AND FUTUNA
WESTERN SAHARA
YEMEN
ZAMBIA
ZIMBABWE
Home Phone Number *
Work Phone Number *
Mobile Number *
Email Address *
What is your preferred method of contact? *
Can we contact you at work?
Yes
No
Do you identify as:
Aboriginal
Torres Strait Islander
Other
What is your cultural background? *
Language/s spoken? *
You are required to have a current NSW Working With Children Check. Please provide your number: *
If you need to obtain a Working With Children Check - please go to https://wwccheck.ccyp.nsw.gov.au/Applicants/Application and apply for one. You will need this prior to submitting your form.
Have you ever had an Apprehended Violence Order (AVO), Domestic Violence Order (DVO) or Personal Violence Order (APVO) issued against you?
Yes
No
If yes, please give details
Have you at any time been the subject of any complaints, investigations (police or disciplinary) or legal proceedings that may affect your suitability to be a volunteer in roles relating to children. This includes any complaints, investigations or proceed
Yes
No
If yes, please give details
Do you have any medical condition (physical or mental) or disability that may need to be taken into account in your role as a volunteer mentor for SHINE for Kids?
Yes
No
If yes, please give details
What distance would you be prepared to travel (when answering this question please consider the method of transport you would likely utilise getting from your own residence to the client, day out and the return trip).
What personal characteristics do you have, which in your opinion, would make you a good mentor?
What would you like to get out of mentoring a young person?
What difference in the life of a young person, are you hoping to make by becoming a mentor?
To become a Volunteer Mentor you will need to commit and be available approximately 4 hours per fortnight for twelve months. Are you are to commit to this amount of time? *
Yes
No
Which days are you likely to be available to volunteer with us? *
Monday
Tuesday
Wednesday
Thursday
Friday
What is your main occupation?
Part of your role as a Volunteer Mentor to a young person will be to visit the young person whilst they are in a Juvenile Justice Detention Centre. Are you able to do this? *
Yes
No
You will be required to attend a two day training course to prepare you for being a Volunteer Mentor and attend other training during the year. Are you willing to attend training? *
Yes
No
Please specify if you are available all day or just in the morning, afternoon or evening.
Referees: Please provide us with three referees who are able to provide us with information about you. The referees you provide must have known you personally for a minimum of 3 years and must NOT be an immediate family member.
Referee 1 Name: *
Phone Number *
Your relationship to this person *
Referee 2 Name: *
Phone Number *
Your relationship to this person *
Referee 3 Name: *
Phone Number *
Your relationship to this person *
Please tick the box after reading the point to acknowledge acceptance of that point:
Are you aware that you must be interviewed and will be required to undergo training by SHINE for Kids before commencing volunteering with us? *
Yes
Are you aware that if you commence volunteering you must agree to adhere to SHINE for Kids policy and procedures, including its Code of Conduct, and policies and procedures regarding Child Protection, Security, Work Health and Safety, Confidentiality and
Yes
Before you can volunteer with SHINE for Kids you must successfully pass employment checks such as: reference checks, Working with Children Check and National Police Record Check.
Yes
You will be covered by Volunteer Personal Accident Insurance whilst undertaking any authorised volunteer work with SHINE for Kids
Yes
I declare that the information I have provided in this application is true and correct to the best of my knowledge. I acknowledge that knowingly providing incorrect information in this application may lead to the termination of my involvement with SHINE
Yes
Applicant's Name *
Date *
Attach Resume (250Mb Limit * )