St Francis School Lockleys eNewsletter

To be considered for a Volunteer role in any capacity in CESA, you must complete all parts of this Declaration, including by providing additional, supporting information and documentation where a “Yes” response has been recorded. You will not be considered unless you complete the Declaration and provide comprehensive and complete information as necessary. If you have any questions about the Declaration, please contact St Francis School, Mr Phil Schultz on 8356 6404.

First Name *

Last Name *

Former Names (if any)

Title *

Mrs

Miss

Other

Email *

DOB *

Address *

Suburb *

Postcode *

Home Phone Number

Mobile Phone Number *

Voluntary position for which this application is being made eg sports coach, attend excursions etc *

Have you ever been investigated, charged, arrested, reported for or pleaded or found guilty of any criminal offence? (Tick ‘No’ where an expiation notice only was received) *

Yes

Other

Have you ever received a written counselling or warning or been dismissed or resigned from any employment or volunteer role in response to, or following allegations of improper or unprofessional conduct in the workplace? *

Yes

Other

Have you ever or are you currently the subject of an investigation or any other process relating to misconduct by you as a volunteer or an employee? *

Yes

Other

Have you ever been the subject of allegations of misconduct by you of a sexual nature towards or in relation to a child (person under 18 years of age) or towards any other person to whom you were responsible for providing care? *

Yes

Other

Our process includes asking referees whether there are any child protection concerns in your regard. Do you foresee any problem arising from this process? *

Yes

Other

PLEASE NOTE: If you answer YES to any of the above questions, you are required to provide comprehensive supporting details, including relevant documentation in order to be considered. (Please upload documents below or bring physical copies into the Front Office.)

(If necessary) Upload files here

I have opted not to answer one or more of the above questions and ask that a meeting be arranged between the Principal (or delegate) and me. Please note: If you wish a meeting to be arranged you must submit your application at least one week prior to commencement date.

Yes

Other

Further information and ongoing requirements

Evidence of a criminal history that may be unrelated to any risk of harm to children will not automatically preclude a person from being or remaining a volunteer.

The requirement for full and honest disclosure is a condition of initial and ongoing engagement. In signing this form you declare that you are a fit and proper person of good character, and you will notify the Principal should there be a relevant change in your circumstances; for example, criminal charges and convictions, restraining orders, intervention orders, injunctions, disciplinary proceedings and investigations.

Please provide this completed declaration form to St Francis School, we may contact you and arrange an interview or an informal conversation.

If you are charged with, convicted of, or granted bail in relation to a sexual offence against a child you are required to inform the Principal/Director immediately and if you are accused, convicted or granted bail you will need to immediately cease providing services to CESA.

Declaration *

I confirm I have read and understood the information provided and am willing to follow St Francis School procedures and policies.

I understand that any false or misleading information I provide will result in me not being considered for a voluntary position or may result in the termination of my position. I declare that I have answered this Volunteer Declaration Form truthfully.

Signed- *

Undo

Clear

Write your signature above the line

MEDICAL/EMERGENCY INFORMATION

Do you have any psychological or medical conditions that might affect your ability to volunteer? Or anything we need to know in case of an emergency? eg diabetes, severe food allergy, asthma, epilepsy. (If yes, provide details below) *

Yes

Are you aware of any medical condition that you have that could result in a medical emergency? (If yes, please provide details of possible emergency and how to recognise it) *

Yes

Emergency Contact Name *

Emergency Contact Number *

Medical Consent

In case of an emergency and in the event that I am unable to give consent at the time, I give the School permission to use their judgement in obtaining any medical attention which they may consider necessary. *

Undo

Clear

Write your signature above the line

CHILD PROTECTION AND PRIVACY

Volunteers play an important role in the education of children and young people in partnership with the staff of Catholic schools. Catholic schools must only engage volunteers who are appropriate, suitably skilled, trained and/or qualified to work with children and young people.

St Francis School is committed to providing the highest possible level of safety and care for students and staff, including volunteers. An integral aspect of this is to ensure that all adults who have access to children and young people during the course of school activities pose no threat to the emotional and physical wellbeing of students. Volunteers are required to complete ‘Responding to the risks of Harm, Abuse and Neglect – Education & Care’ training for volunteers. St Francis School also requires all volunteers to obtain and hold a valid and current Child-Related Employment Screening Clearance.

Upon receipt of an individual’s Volunteer Application, the Principal or their delegate will forward relevant screening information to the Catholic Education Office for processing. All other information that relates to the privacy of individuals will be held at St Francis School in a secure place and only accessed by the Principal or their delegate.

SCREENING

I understand that in order to volunteer within CESA, a range of screening procedures, including holding a valid and current Child-Related Employment Screening Clearance, is required for all long term volunteers. I understand that I will not be able to commence volunteering until clearances have been received? *

Yes

• I agree to take all reasonable steps to protect my own health and safety and that of others while on school property and/or while undertaking duties for the school.
• I agree to keep confidential any personal or sensitive information of which I become aware through my involvement with the school.
• I declare that I have answered this form truthfully. I understand that any false or misleading information I provide will result in me not being considered for volunteer work or may result in the termination of my services.
• I have read the a Volunteer Induction Pack including the ‘Responding to the risks of Harm, Abuse and Neglect – Education & Care’ Volunteer Handbook, and the Volunteer Details, Declaration and Induction Checklist, and Work Health and Safety information for volunteering at the school. I have read and understood the contents and sought and received adequate explanation for any queries I have had.
• I acknowledge that this completed form will be kept on file at the school.

Signed *

Undo

Clear

Write your signature above the line

PERSONAL REFEREES

St Francis School will contact referees who know you and are able to attest to your good character.

Referees should include professional referees (eg, previous or current employer, lawyer, JP, work colleague)

Please advise your referee they will receive a phone call from the school, if we are unable to contact them it will delay the approval process.

Thank you for applying to volunteer at St Francis School.

REFEREE 1: NAME *

Work place and position/role *

Address *

Phone number: *

How do you know this person? *

Lawyer

Employer

Work colleague

other (please specify)

Details of relationship

REFEREE 2: NAME *

Work place and position/role *

Address *

Phone number: *

How do you know this person? *

Lawyer

Employer

Work colleague

other (please specify)

Details of relationship

PERSONAL INFORMATION

Are you a parent or guardian of a child at this location? *

yes

Please give detail: *

VOLUNTEER APPLICATION AND DECLARATION

MEDICAL/EMERGENCY INFORMATION

CHILD PROTECTION AND PRIVACY

SCREENING

PERSONAL REFEREES

PERSONAL INFORMATION