Outback Helpers - Registration Form for Helpers
Contact Information
> Name: ......
> Address: ......
> Telephone No. Home: ( ) ...... Mobile: ......
> Email Address: ......
General Information please fill in the following questions circle/tick/write your answers for each question below.
> UHF Call Sign: ......
> Age Bracket: please select an age bracket [40’s-50’s] [50’s-60’s] [60’s-70’s] other......
> Number in your group: Male ...... Female ...... Children ......
> When are you planning to travel? ......
> Where on your travels are you available? (Preferred State) ......
> Type of Vehicle: 2wd/4wd Towing? (Caravan etc.)
> Skills you can provide: (e.g. Carpentry, mechanical, sewing, cooking, handyperson etc)
......
......
......
> How long did you anticipate staying in a particular place:
[...... days] [...... weeks] [...... months] [...... flexible] [...... until the job is done]
> Do you wish/need to be paid for your work? [...... Yes] [...... No]
or are you happy to accept accommodation, power, food and fuel? [...... Yes]
(This will help us with our placement, as some people are unfortunately not in position to pay helpers.)
> What accommodation do you need?
[.....room] [.....food] [.....electricity] [.....self-sufficient]
> Where did you hear about the Outback Helpers? ......
> Do you have:
Police Clearance: [..... Yes] [.....No]- First Aid Certificate: [..... Yes] [.....No] - Pets with you? [...... Yes] [...... No]
> Can you provide the names & phone numbers of 2 referees should ‘Hosts’ wish to contact them?
1......
2......
Signature: ...... Date: ...... /...... /......
A once only fee of $20.00 per couple or $10 per single would be appreciated to help cover administration costs.
These details are required for our normal contact with you, they also enable us to place you with a Host
Station/Farm that meets your needs.
> You don’t have to answer any question you would rather not.
> All helpers filling out an employment application will be covered by the worker’s compensation of that place.
> Some Stations are 4wd access only.
It is up to the Helpers and Hosts to negotiate the suitability, financial and pet arrangements before your visit.
You are required to contact us each time you wish to be placed on a ‘Host Station’.Disclaimer: While the ‘Outback Helpers’ scheme has attempted to ensure the information passed on in our publications and other communications is correct, we cannot warrant the information is accurate and complete, nor will we be liable for any loss suffered by any person because they rely on it in any way.
______
Greg & Jenny Watters, Mount Clere Station, MEEKATHARRA. WA. 6642
Phone no: (08) 9981 2943 - Fax: (08) 9981 2959 - Email:
Ted and Jean Winterfield, 34 Acacia Street, MT GAMBIER. SA 5290
Phone no: (08) 8725 4463 - Mobile: 0407 973 059 - Email:
Rosie Bryant, Albury Station, Mungallala, Qld 4467.
Ph: 07 46231 839 Email:
Ron Smith and Janis Skene Mobile: 0429 955 935 Email:
Our website is http://www.outbackhelpersscheme.com