Volunteer Application Form (Online)

Part 1 - Personal Details
Surname*
Given Name(s)*
Preferred Name*
Title*
Gender*
Date of Birth*
DD slash MM slash YYYY
Citizenship*
Passport / Visa Details
Working with Children Card*
Do you have a current WWCC?
WWCC Number
WWCC Expiry Date
DD slash MM slash YYYY
Western Australian Department of Education SCN
Do you have a current SCN? (WA applicants only)
SCN Number
SCN Cleared
DD slash MM slash YYYY

Part 2 - Contact Details
Address*
Suburb*
State*
Postcode*
Postal Address As Above*
Postal Address*
Postal Suburb*
Postal State*
Postal Postcode*
Please fill in at least one phone contact number
Phone (Home)
Phone (Work)
Phone (Mobile)
Email*
You will need your own email address in order to complete the form online

Part 7 - Referees
Please provide TWO referees who are NOT family members or a partner you live with, and who have known you for at least TWO years. Where possible please include email addresses. These people will be contacted prior to acceptance of your application. Please let your referees know that we will be contacting them.
Referee 1 Name*
Referee 1 Email
Referee 1 Telephone (office hours)*
Referee 1 Position / Relationship to you*
Referee 2 Name*
Referee 2 Email
Referee 2 Telephone (office hours)*
Referee 2 Position / Relationship to you*

Part 8 - Other Information
Ethnicity*
This information is collected for statistical purposes. Please select one only. Source: 1249.0 - Australian Standard Classification of Cultural and Ethnic Groups (ASCCEG), 2011
How did you hear about the program?*
- Brochure / Flyer
- School
- Workplace
- Word of mouth
- Internet
- Presentation
- Volunteer Centre
- Media - Radio / Newspaper
- Other
How did you hear about the program (Other)?

Part 9 - Declaration / Submission
Volunteer's Code of Conduct*
I acknowledge that I have read and agree to the Volunteer Code of Conduct. Please click here to read the Volunteer's Code of Conduct.
- Yes
- No
Volunteer Information Sharing*
I agree to my personal information being disclosed to relevant third parties (including, but limited to, schools, relevant state department of Education, and child protection agencies).
- Yes
- No
Volunteer Image Use and Identification*
I give permission for EdConnect Australia to use images of me for training and publicity purposes. I also agree to being identified when images of me are used for training and publicity purposes.
- Yes
- No
Applicant's Full Name / Signature*
Submission Date
DD slash MM slash YYYY
Privacy Statement Your personal information is handled in accordance with our privacy policy. EdConnect will take all reasonable steps to protect sensitive and personal information. Our privacy policy can be found at www.edconnectaustralia.org.au/policies
Please tick the box below before submitting the form.
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Confidential Volunteer Application Form