The information collected on this form is to be used as part of the evaluation process of becoming a Volunteer Mentor for SHINE for Kids.  Should you be successful, this information shall be kept on file as a record.

Children have the right to be protected from all kinds of harm. SHINE for Kids is committed to creating and maintaining a safe environment for children and young people and conducts comprehensive background checks for all applicants.

If you have any difficulties completing this form or would like to know more please call (02) 9714 3000.

If you would like to print this form and fill it out, you can download the form here.

If you would like to send this form in the mail, please send it to:

The Returned and Services League of Australia (NSW Branch)
RSL and SHINE Mentoring Program
ANZAC House
245 Castlereagh Street,
Sydney. NSW. 2000

 

 

* Required

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 ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA 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 EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS (MALVINAS) FAROE ISLANDS FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA FRENCH SOUTHERN TERRITORIES GABON GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUERNSEY GUINEA GUINEA-BISSAU GUYANA HAITI HEARD ISLAND AND MCDONALD ISLANDS HOLY SEE (VATICAN CITY STATE) HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN, ISLAMIC REPUBLIC OF IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JERSEY JORDAN KAZAKHSTAN KENYA KIRIBATI 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 SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS SPAIN SRI LANKA SUDAN SURINAME SVALBARD AND JAN MAYEN SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAIWAN TAJIKISTAN TANZANIA, UNITED REPUBLIC OF THAILAND TIMOR-LESTE TOGO TOKELAU 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 *)