Volunteers Declaration

VOLUNTEER CHURCH WORKER'S DECLARATION

Thank you for your desire to volunteer at Abundant Life Centre Busselton. This declaration is part of our church’s commitment to ensuring our duty of care for all people, and also to fulfil our insurance obligations, health and safety and other requirements.

Please ensure you have read the ACC Volunteer's Code of Conduct before completing this declaration, as this is what you are agreeing to adhere to as a volunteer.

PERSONAL DETAILS

* Indicates required field

Name *

First

Last

Any former names *

Gender (M/F) *

Date of Birth (dd/mm/yyyy) *

Email *

Address *

Mobile Phone *

Home Phone *

CRIMINAL HISTORY CHECK AND/OR WORKING WITH CHILDREN CHECK

I hereby consent to an Australian Federal Police Check if one is considered necessary for my role. My state based working with children check (or similar) details, where required are as follows:

State of Issue: *

Reference Number: *

Expiry Date *

CONSENT TO HOLD INFORMATION

I consent to the information contained in this application including the subsequent pages to be kept by our church. I understand that this information will be kept in a confidential file and used only for screening and disciplinary purposes.

REFEREE CHECK (if you have been at the church for less than 3 years)

Please nominate a character reference (name) *

Relationship *

Contact Number *

Name of my previous church and pastor (if applicable) *

DECLARATION

(1) I understand that the church operates in an environment of numerous legal and ethical restrictions, and I will fully cooperate with the church in abiding by these. I assure the church, in considering me for a volunteer role that:
• I have no health impediment that will put me or any other person at risk in the fulfilment of my designated role
• Other than those matters disclosed by me to the church (noted above) at the time of making this declaration, I know of no past behaviour that renders me unfit to serve as a volunteer or which detracts from the obligation of the church to operate as a place of safety to a minor or any other person. Such past behaviour may include being the subject of an allegation of sexual abuse (whether convicted or not), including any type of molestation, indecent exposure, sexual harassment or intimidation.

(2) I understand that if I am unclear as to any of the statements in this document, I will seek clarification from a team leader or church leader before signing.

(3) I have provided this information, and any documents accompanying it in good faith and declare they are true and correct to the best of my knowledge and belief.

(4) I understand that any material misstatement in or omission from this questionnaire may render me unfit to hold a particular role in the church.

(5) I have received a copy of the Volunteer Church Workers Code of Conduct, read it, and I agree to uphold it.

(6) I understand that when considering whether there is an avenue for my voluntary services, my church may refer to ACC and local church policies, guidelines and position papers.

(7) I will respect the decision of my church as to where I volunteer my services within the church, and whether my services are required, from time to time.

(8) I understand that a team leader will be available to me to discuss my service.

Volunteer’s signature (just enter your name) *

Parent / Guardian Permission - if you are under 18, do you have permission from a parent / guardian to sign this declaration and serve at ALC? *

Date of application (dd/mm/yyyy) *

Have you read the Volunteer Church Workers Code of Conduct? *

Endorsement of church leadership for this person to volunteer: _____________________ Date: _/_/____

Submit