volunteer f Gasbags North East VOLUNTEER CHAIRPERSON APPLICATION FORM Personal / contact details: Date / / Name Address Phone 1 Date of birth / / Email address Preferred method of contact Current occupation / study  Work  Study  Full time  Part time Details:  Work  Study  Full time  Part time Details: Emergency Contact Details: Name: Relationship to you: Phone 1: Phone 2: Referees. Please provide the name and contact details of at least two referees: Name:  Male  Female Phone1: Phone2: Relationship to you: Name:  Male  Female Phone1: Phone2: Relationship to you: Experience and qualifications. Please provide details of experience relevant to this role Please tick any of these skill areas if they relate to you:  Training or education in teaching or tutoring  Experience teaching or tutoring school students  Experience teaching English as a Second Language  Speciality knowledge in a particular VCE subject area  Experience working with young people  Experience working with people from refugee or migrant backgrounds Please elaborate on these experiences in the space below: Languages spoken Other voluntary work Hobbies / Interests Why are you interested in becoming a Gasbags North East volunteer? Please indicate your availabilities in the space below  Where did you hear about Gasbags North East Chairperson vacancy? Personal Information: Age  <18  18-25  26-35  36-45  46-55  55+ Gender  Male  Female  Other ( please state/ prefer not to ) Language spoken at home? Highest education qualification achieved? Privacy statement: The personal information on this form is being collected for the purposes of recruiting and selecting volunteers wishing to work in XYZ Homework Club. The information may also be required for evaluation purposes. Any evaluation reports developed will not identify individual volunteers by name. This information may be shared with Out of School Hours Learning Support Program partner organisations and funding bodies.  Please tick if you would like to receive regular newsletters for tutors working in Out of School Hours Learning Support Programs. By signing this form I attest that the information supplied is true and accurate. I understand that submitting this application form does not automatically register me a volunteer tutor but that there is a selection process including completion of a satisfactory Working With Children Check and participation in training. I confirm that I am willing to volunteer as a tutor for at least a six month period and to attend XYZ Homework Club a minimum of one evening each fortnight. Signature: Name: Date: XYZ Homework Club is committed to the safety and wellbeing of all children and young people accessing our service. We support the rights of the child and will act without hesitation to ensure a child-safe environment is maintained at all times. We also support the rights and wellbeing of our staff and volunteers and encourage their active participation in building orm