Volunteer Application form (schedule 4) • Mount Isa Baptist

PERSONAL DETAILS

First Name

Preferred Name

Occupation

Last Name

Date of Birth

Home Address

Home Post Code

Mailing Address

Mailing Postcode

Phone Number

Email Address

EMERGENCY CONTACT DETAILS

Emergency Contact - Name

Emergency Contact - Phone

Emergency Contact - Relationship

PREVIOUS CHURCH DETAILS

Name of Church

Church Phone Number

Name of Pastor

PLEASE TELL US ABOUT YOURSELF

Please outline your reasons for offering to work with children.

What experience do you have working with children?

Please list any relevant qualifications and/or training that you have attained (including first aid).

Is there any medical condition, relevant information or limitation (e.g. epilepsy) that may affect your ability to fully participate as a volunteer? (Please give details)

CHILD PROTECTION STATEMENT & PRIOR CONDUCT

Children who are involved in our activities should receive the highest possible standard of care and protection. Therefore, in all our work, we seek to ensure the well-being and development of each child. Within this context, you are committing yourself to the protection of children from all forms of abuse. *

Yes

Have you been interviewed, questioned or charged by Police in relation to any offence involving children, violence, alcohol or drugs? *

Yes

Tip: (If ‘yes', please give details or please discuss with the Safe Spaces Coordinator or member of the Governance team.)

Additional details (if required):

Have you been convicted of any offence involving children, violence, alcohol or drugs? *

Yes

Tip: (If ‘yes’, please give details or please discuss with the Safe Spaces Coordinator or member of the Governance team.)

Additional details (if required):

All applicants are required to have a 'Blue Card.'

Read the Safe-Spaces-Safeguarding-Policy-MIBC

Have you read, understood, and will you abide by, the 'MIBC Safe Spaces Safeguarding Policy'? *

Yes

What area of ministry(s) are you applying for?

DECLARATION *

Yes

I confirm that the information contained in this application is true and correct.

I agree to complete the required training components in Safe Ministry Check; and read, sign and abide by the Mount Isa Baptist Church Code of Conduct (as set out in Safe Ministry Check).

If applicant is under 18, parent or guardian must also sign below.

Applicant Name (and signature if printed form)

Date