Nundah Activity Centre 15 Jenner Street, Nundah QLD 4012 T: (07) E:

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1 Hello, Thank you for your interest in volunteering your services to Nundah Activity Centre (NAC). My name is Don Rudd and I am the General Manager of NAC. Here at NAC, one of the important jobs is to recruit, place and guide volunteers for a variety of activities in the NAC community. Our Vision NAC will be the centre of choice of our 50+ community for the provision of services and recreational needs that enhance and energise the lives of our members and clients with dignity, compassion and commitment. Our Mission NAC is a not for profit community organisation dedicated to energising the lives of everyone in the community focusing especially on 50+ and senior citizens in Nundah and surrounding suburbs. Our Values We value the contribution of each person makes to our society in general and our community in particular, and, in return, we provide high quality services efficiently and equitably to help each person achieve fulfilment in whatever way we can. We request all volunteer applicants to provide some personal details to ensure we can contact you in the event of any changes to planned arrangements and to enable us to protect your safety in the event of any accident or emergency. The completion of the Work Preferences/History section of the application form enables us to gather relevant information to design for you a position that uses your skills and qualifications, links you into your preferred work area, and offers a satisfying work experience for you. Please complete and return the Volunteer Application form. A Volunteer Coordinator will contact you to arrange an introductory interview and to plan your induction program. We like to put a face to a name. These interviews will be conducted here at NAC or by Skype. In these interviews we do two things we help potential volunteers with the form and address any questions they may have. The application form includes a contact details to show what is expected of the volunteer and an application for a Police Check (we absorb that cost). The information provided in the forms is required for insurance purposes and will not be passed on to any third party apart from aged care facilities who are working with us on the Community Visitors Scheme programs with your consent. If you would like more information on our organisation, please visit our website nac.org.au. Alternatively if you would like to organise to meet (in person or virtually) please send me an at volunteer@nac.org.au. Thank you for your interest and we hope to hear from your soon. Don Rudd General Manager Nundah Activity Centre (NAC) 1 P a g e

2 PERSONAL DETAILS Name Address Preferred Phone Contact No. Date of Application Date of Birth Name of Emergency Contact Person Emergency Contact Person s Phone No. How did you hear about Nundah Activity Centre? WORK PREFERENCES/HISTORY Motivation, Skills and Competencies Briefly explain why you would like to work for us Occupational background (current or previous) 2 P a g e

3 Motivation, Skills and Competencies What are your special interests/skills? Do you have any particular qualifications or competencies that you could contribute to your volunteer role? (Please include any computer competencies etc.) Availability How much time would you like to give? (Specify the number of hours or days per month) When are you available? (Specify which days/times best suit you) Work Preferences Morning Afternoon Evening Monday Tuesday Wednesday Thursday Friday What type of voluntary work would you like to do? (please check your preferred areas) 1. Office assistance (reception/phone answering) 2. Publishing the newsletter 3. Catering/kitchen assistant 4. Music activities 5. Assisting with clients indoor activities 6. Assisting with clients outdoor activities 7. Friendly visiting at client s home and/or Aged Care residence 8. Assisting with transport 9. Assisting with shopping 10. Fund-raising activities 11. Translation/interpreting assistance 12. Special support for clients from a different cultural background 13. Special support for clients from an Indigenous background 14. Computer services (IT Support, social media use) 15. Board Member 16. Other (please explain) Work Preferences (cont d) If you checked 11, 12 or 13, please state the ethnic/cultural background/s you are 3 P a g e

4 familiar with or have a personal association with? Do you have any medical conditions that may impact your volunteer engagement based on the work preferences outlined above? Yes If YES, please list below. No Do you speak a language other than English? Yes No If Yes, please list below the languages/dialects you speak, and whether you are fluent, or have some basic skills. Do you have your own transport? Yes No Do you hold a current driver s licence? Yes No Licence Number and expiry Number Expiry Insurance details (for volunteer drivers) Are you an Australian Citizen or Permanent Resident? Yes No Do you have a current national Police check? (no older than 3 months) Yes No I confirm that the information I have provided above is true and accurate. I have not withheld any information relevant to my application as a volunteer for Nundah Activity Centre nor have I been refused admission to, or been removed from any other organization previously. I understand that it is my responsibility to inform Nundah Activity Centre of any changes to the information provided. Name of Volunteer/Employee/Contractor Signature Date I acknowledge that NAC will perform a police check on me and my application will depend on the results. I agree that the information contained in this form may be supplied to an aged care home for the purpose of matching me as a visitor to a resident (if that is the preferred volunteer role). Signature Date 4 P a g e

5 VOLUNTEER RIGHTS AND RESPONSIBILITIES As a NAC volunteer you have the right to: Be provided with information about the Volunteer role you have been engaged to undertake Receive a Position Description (PD) for the role Know to whom you are accountable Receive clear and concise written instructions Receive information on the duty of care requirements where applicable Be respected and supported Say no to unacceptable tasks Be linked to others undertaking similar roles and valued as a team members Be offered the opportunity to attend information sessions Not be exploited Be informed of any change of circumstances as required Have complaints and concerns addressed Be reimbursed for out of pocket expenses, if requested Work in a safe and healthy environment Be covered by insurance. 5 P a g e

6 QUEENSLAND POLICE AUTHORITY AND INDEMNIFICATION CONSENT TO CHECK NATIONAL POLICE RECORDS AND ADVISE A THIRD PARTY <Family Name> MR/MRS/MS/MISS <Given names> <Former Maiden Name, Married Name/s, or Aliases> <Residential Address Telephone Private ( ) Business ( ) Mobile DATE OF BIRTH / / PLACE OF BIRTH e.g. Brisbane, Australia PROOF OF IDENTITY Attach a legible photocopy of your current Driver's License OR photocopy of your current passport including photograph and signature OR photocopies of two other forms of identification bearing your signature NAME OF THIRD PARTY NUNDAH ACTIVITY CENTRE This check is for the purpose of undertaking work with the Third Party that is unpaid as a volunteer. 1, whose personal particulars are set out above, authorise the Commissioner of Police or his servants or agents to: check my name against records that are held by the Queensland Police Service or are available to them nationally from other Australian Police Services, and I further agree to provide my fingerprint impressions if required for checking purposes, and if I do not have a conviction or if I only have a conviction that cannot be disclosed by virtue of the Criminal Law (Rehabilitation of Offenders) Act 1986 (Old) to advise the above-named third party that I do not have a conviction that can be disclosed. If I have a conviction that can be disclosed, I authorise the disclosure to the above-named third party of the details of that conviction. I clearly understand that any details disclosed to the above- named third party will be considered by them and may affect any application I have made with them for a position of trust or employment, or as the case may be. I hereby agree not to take or suffer or permit to be taken any legal action whatsoever or howsoever against the Crown in the right of the State of Queensland, the Commissioner of Police or any member or agent of the Queensland Police Service in respect of advice given to a third party or the disclosure or use of information relating in any way to records under the names supplied. SIGNATURE OR PERSON IN THE PRESENCE OF SIGNATURE OF WITNESS PRINTED NAME OF WITNESS DATE / / 6 P a g e

7 Commonwealth of Australia STATUTORY DECLARATION Statutory Declarations Act Insert the name, address and occupation of person making the declaration I, 1 make the following declaration under the Statutory Declarations Act 1959: 2 Set out matter declared to in numbered paragraphs 2 1. I declare that (place a tick or cross in applicable box): since turning 16 years of age, I have been a citizen or permanent resident of a country/countries other than Australia. since turning 16 years of age, I have never been a citizen or permanent resident of a country/countries other than Australia 2. I declare that I have never been: (a) convicted of murder or sexual assault; or (b) convicted of, and sentenced to imprisonment for, any other form of assault. I understand that a person who intentionally makes a false statement in a statutory declaration is guilty of an offence under section 11 of the Statutory Declarations Act 1959, and I believe that the statements in this declaration are true in every particular. 3 Signature of person making the declaration 4 Place 5 Day 6 Month and year 3 Declared at 4 on 5 of 6 Before me, 7 Signature of 7 person before whom the declaration is made (see over) 8 Full name, qualification and address of person before whom the declaration is made (in printed letters) 8 Note 1 A person who intentionally makes a false statement in a statutory declaration is guilty of an offence, the punishment for which is imprisonment for a term of 4 years see section 11 of the Statutory Declarations Act Note 2 Chapter 2 of the Criminal Code applies to all offences against the Statutory Declarations Act 1959 see section 5A of the Statutory Declarations Act P a g e

8 A statutory declaration under the Statutory Declarations Act 1959 may be made before (1) a person who is currently licensed or registered under a law to practise in one of the following occupations: Chiropractor Dentist Legal practitioner Medical practitioner Nurse Optometrist Patent attorney Pharmacist Physiotherapist Psychologist Trade marks attorney Veterinary surgeon (2) a person who is enrolled on the roll of the Supreme Court of a State or Territory, or the High Court of Australia, as a legal practitioner (however described); or (3) a person who is in the following list: Agent of the Australian Postal Corporation who is in charge of an office supplying postal services to the public Australian Consular Officer or Australian Diplomatic Officer (within the meaning of the Consular Fees Act 1955) Bailiff Bank officer with 5 or more continuous years of service Building society officer with 5 or more years of continuous service Chief executive officer of a Commonwealth court Clerk of a court Commissioner for Affidavits Commissioner for Declarations Credit union officer with 5 or more years of continuous service Employee of the Australian Trade Commission who is: (a) in a country or place outside Australia; and (b) authorised under paragraph 3 (d) of the Consular Fees Act 1955; and (c) exercising his or her function in that place Employee of the Commonwealth who is: (a) in a country or place outside Australia; and (b) authorised under paragraph 3 (c) of the Consular Fees Act 1955; and (c) exercising his or her function in that place Fellow of the National Tax Accountants Association Finance company officer with 5 or more years of continuous service Holder of a statutory office not specified in another item in this list Judge of a court Justice of the Peace Magistrate Marriage celebrant registered under Subdivision C of Division 1 of Part IV of the Marriage Act 1961 Master of a court Member of Chartered Secretaries Australia Member of Engineers Australia, other than at the grade of student Member of the Association of Taxation and Management Accountants Member of the Australasian Institute of Mining and Metallurgy Member of the Australian Defence Force who is: (a) an officer; or (b) a non-commissioned officer within the meaning of the Defence Force Discipline Act 1982 with 5 or more years of continuous service; or (c) a warrant officer within the meaning of that Act Member of the Institute of Chartered Accountants in Australia, the Australian Society of Certified Practising Accountants or the National Institute of Accountants Member of: (a) the Parliament of the Commonwealth; or (b) the Parliament of a State; or (c) a Territory legislature; or (d) a local government authority of a State or Territory Minister of religion registered under Subdivision A of Division 1 of Part IV of the Marriage Act 1961 Notary public Permanent employee of the Australian Postal Corporation with 5 or more years of continuous service who is employed in an office supplying postal services to the public Permanent employee of: (a) the Commonwealth or a Commonwealth authority; or (b) a State or Territory or a State or Territory authority; or (c) a local government authority; With 5 or more years of continuous service who is not specified in another item in this list Person before whom a statutory declaration may be made under the law of the State or Territory in which the declaration is made Police officer Registrar, or Deputy Registrar, of a court Senior Executive Service employee of: (a) the Commonwealth or a Commonwealth authority; or (b) a State or Territory or a State or Territory authority Sheriff, Sheriff s officer Teacher employed on a full-time basis at a school or tertiary education institution 8 P a g e

9 CONFIDENTIALITY AGREEMENT I hereby agree that I will maintain at all times the confidentiality of all privileged or proprietary information to which I am exposed whilst working as an employee/volunteer with Nunda Activity Centre (NAC) whether the information involves a client, a paid staff person/volunteer or other person, or involves NAC. Name of Employee/Contractor/Volunteer Signature Date Name of Witness Signature Date 9 P a g e

10 Confirmation of Induction In signing this document you agree that you have received: An information pack including but not restricted to: Volunteer application form Copy of Volunteer Rights Police Check application form A Statutory declaration form A Position Description will be given at time of interview. A letter of Confirmation of Agreement will be sent after the interview outlining what has been agreed and act as a Memorandum of understanding between both parties. Signed: Name: (Volunteer) Date: Administration Processed by: Date: Task allocation and timeframe (list): P a g e