VOLUNTEER APPLICATION FORM

Please fill in this form, print it, then sign and date it and either fax it to our office 08 8331 2644, or mail it to:

Holiday Explorers Inc

1 Brand Street

BEULAH PARK

SA 5067

Or drop your application in to Gill at the office.

The next step is an interview at the office. If you decide to proceed further with your application we will undertake Police and reference checks, and ask you to attend two training sessions and two observation holidays.

PERSONAL & CONTACT DETAILS
----------------------------------------------------------------------------------------------

Given Name:

Surname:

Preferred name:

Address:

Phone No.

Work
Mobile

Email

Male Female

Date of birth

Age (minimum age 20)

EDUCATION & EMPLOYMENT INFORMATION

----------------------------------------------------------------------

Please list any formal Vocational or Tertiary qualifications

Are you currently enrolled in any courses?

(Please state which institution, which course, and the estimated year of completion)

Have you completed any certificates, courses, workshops or seminars that may be relevant.

(Please list dates, details and the name of the organiser)

What is your current occupation?

	Date Commenced	Employer	Duties (in brief)

Please provide a brief history of your employment and work experience.

	Date to - from	Employer	Duties (in brief)

Please highlight any work skills or experience that you feel are relevant for escorting people with an intellectual disability on a holiday.

Do you receive a pension? Yes No

If yes, what type of pension?

Pension Number

DISABILITY AWARENESS

Have you assisted or worked with a person with any type of disability before? Yes No

If Yes, please provide details of what your role was.

Please describe your understanding of what an intellectual disability is.

(Please note – our comprehensive training will assist if this is new to you)

PERSONAL ATTRIBUTES & HEALTH
----------------------------------------------------------------------

Please describe the personal qualities that you believe would make you a suitable person to accompany Holiday Explorers Tourist Members on holiday.

Is there a particular age range with which you work well?

( e.g. Youth / Older Adults - Please explain)

Have you had any experience in working within a small team to achieve common goals? (Please describe)

Are you a confident swimmer? Yes No
(This is not essential for volunteers)

Have you any qualifications in this area? Yes No

Please indicate any recreational / leisure activities you enjoy and your level of experience and expertise in these areas.

How would you rate your current level of physical fitness?

Below average Average Good Very good

What type of regular physical activity do you undertake?

Frequency:

less than 1 day a week

1 x per week

2 - 4 x per week

4 – 6 x per week

Do you have any medical conditions that may affect your performance in a supporting role? Yes No

If yes then please describe.

Please note: Holiday Explorers recommend that all volunteers over the age of 50 undertake a medical check with their General Practitioner before commencing at Holiday Explorers. (A medical check list will be provided at the interview)

VOLUNTEER REQUIREMENTS
----------------------------------------------------------------------

Do you hold a current first aid certificate? Yes No

Expiry date.

Do you hold a current driver’s licence? Yes No

Licence number & expiry date.

Type of licence

Have you had any traffic infringements in the past 5 years?

Yes No

If yes, please describe.

Have you been convicted of a criminal offence?
Yes No

If yes, please provide details.

Police checks are compulsory for all Holiday Explorers volunteers. Do you have any objection having a police check on you? Yes No

If yes, please explain

AVAILABILITY
----------------------------------------------------------------------

When are you most likely to be available to volunteer for Holiday Explorers? (Please tick the relevant boxes to indicate when you would be available)

DAY TRIPS: (NOT AWAY OVERNIGHT)

WEEKDAYS: Mon. Tues. Wed. Thurs. Fri.

WEEKENDS: Sat. Sun.

WEEKENDS & PUBLIC HOLIDAYS ( INCLUDE AN OVERNIGHT STAY)

WEEKDAYS: 1 night away

WEEKENDS: 1 night away

LONGER HOLIDAYS

BETWEEN TWO – FIVE NIGHTS AWAY:

Two – three

Four – five

MORE THAN FIVE NIGHTS AWAY:
Five – seven
Eight – ten
Eleven - fourteen

Please indicate if you are available at short notice?
Yes No

Are you available to attend regular volunteer development and training workshops during the year (including a residential workshop over a weekend, and two one-day workshops usually held on a Saturday.)
Yes No

Please summarise your strengths and experience that would enable you to relate well with people who have an intellectual disability, and assist them in an appropriate manner.

REFERENCES

----------------------------------------------------------------------

Please provide the names, addresses & telephone numbers of two people who would supply character and work experience references and, if possible, a recent written reference.

Name
Phone

Address

Occupation

Name
Phone

Address

Occupation

DECLARATION & SIGNATURE

----------------------------------------------------------------------

I declare the preceding information to be true and correct to the best of my knowledge.

Signed …………………………………………… (Applicant)

Please print name ………………………………………………..

Date ……………………………...

Please return as per directions at top of page.

Thank you.