Bankstown Meals on Wheels

Volunteer Registration Form

First Name *

Last Name *

Home Phone: *

Mobile:

Email Address *

Home Address Details *

Street address *

City *

State *

Postcode *

Is your mailing address the same as your street address? *

YesNo

Mailing Address (if different to street address)

Street address

City

State

Postcode

Date of Birth *

Country of Birth

Preferred Language *

Permanent Resident *

YesNo

If no, how long can you stay in Australia? *

Volunteer Role you are applying for *

Delivery DriverDelivery Runner

Motivation, Skills and Experience

Why are you interested in volunteering? *

Have you done any volunteering before? *

YesNo

If yes, please give details *

Please provide relevant qualifications, skills and work experience

Hobbies and Interests

Availability

What times are you available to volunteer? *

8-10am10am-noon11am-1pmAnytime

Driving Information

Do you hold a current Drivers Licence? *

YesNo

Licence Number *

Licence Expiry *

In the last 5years, have you had any driving restrictions or convictions? *

YesNo

Please provide details *

Do you have your own transport? *

YesNo

Registration Number: *

Registration Expiry Date *

Do you have Comprehensive Motor Vehicle Insurance? *

Yes No

Comprehensive Motor Vehicle Provider *

Comprehensive Motor Vehicle Insurance Policy Number *

Policy Expiry Date *

Upload copy of Comprehensive Motor Vehicle if available

Browse

(Only cars with current Comprehensive Motor Vehicle Insurance may be used for Council activities)

Health Information

Do you have any health problems? *

YesNo

Please provide details regarding health *

Emergency Contact Person 1 - Name *

Emergency Contact Person 2 - Name

Emergency Contact Person 1 - Home Phone *

Emergency Contact Person 2 - Home Phone

Emergency Contact Person 1 - Mobile

Emergency Contact Person 2 - Mobile

Emergency Contact Person 1 - Relationship *

Emergency Contact Person 2 - Relationship

Emergency Contact Person 1 - Address *

Street address *

City *

State *

Postcode *

Emergency Contact Person 2 - Address

Street address

City

State

Postcode

Criminal Record Check

Due to the nature of the work, and vulnerability of the clients, we are required to ask the following questions

Have you been convicted of a criminal offence in the past five years or are you currently facing any charges for a criminal offence? *

YesNo

Please provide details of offence and current status *

Do you agree to a Criminal Record Check? *

YesNo

Referee Check

Please provide the names of two (2) referees:

Referee Person 1 - Name *

Referee Person 2 - Name *

Referee Person 1 - Daytime phone *

Referee Person 2 - Daytime phone *

Referee Person 1 - Mobile

Referee Person 2 - Mobile

Referee Person 1 - Email

Referee Person 2 - Email

Signature and Submission

Thank you for your interest in volunteering and the time taken to complete this form. If you have any questions please contact Council's Team Leader Food Services on Ph: 9707 9646 or email mealsonwheels@cbcity.nsw.gov.au

Signature *

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Privacy Notice

In submitting this form, you consent to Council:

1. collecting your personal information as contained in the form; and

2. using the information for the purposes outlined in the form and for any other Council function.

Providing your information is voluntary. Should you choose not to provide the information, Council is unable to process your application/request. You may access any of your personal information that Council holds upon request.

This form is confidential