Community Integration Program

VOLUNTEER APPLICATION FORM

Full Name: (Please circle appropriate) Ms / Mrs / Mr
Address: / Postcode:
Email: / Date of Birth:
Mobile no.: / Home no.: / Work no.:
Gender: / □Male □Female
Do you hold a current Driver’s Licence: / □ Yes □No
Do you have a Working With Children Check card?
If ‘yes’, please include a photocopy of the card when you return this form: / □ Yes □No

POLICE SECURITY CHECK

Whitelion requires all volunteers and staff to undergo a police check. Please notify the Community Integration Leader if you expect offences to be listed (Disclosure of offences does not necessarily preclude you in becoming a volunteer).

Your consent to such a check is both required and appreciated, and any information disclosed through these checks will remain confidential.

The details I have provided are accurate and I consent for them to be submitted for a police check.

Signed:______signed on file______Date:______

Have you had previous volunteer roles?□Yes□No

If ‘yes’, please list them below:

Organisation:
Role:
Duration: / Organisation:
Role:
Duration:

CIP Volunteer ApplicationPage 1 of 5Issue date: 09/01/15

What are your interests? For example: sport, the arts? (e.g. football, cricket, netball, photography, theatre, music, construction skills, cars).

What community groups are you, or have you been, involved in?

What is your availability for the CIP?

Which days?

Which nights?

What times?

Which geographical area? What suburbs or towns?

Is there anything else you would like to add?

WHAT IS REQUIRED OF YOU

Supervision and Support

It is recognised that working with young people in residential care can be overwhelming and confronting, particularly in a one-on-one relationship in a community environment. Close support, guidance and supervision is not only available to all volunteers but is a requirement of participation in the program. With this in mind, all volunteers must have phone contact with their Community Integration Leader at least fortnightly, in addition to at least one face-to-face meeting per quarter.

Are you able to commit to the requirements above?

□Yes□ No

What other types of support do you feel you would need as a CIP volunteer?

Commitment

Whitelion’s programs aim to reflect best practice standards in our dealings with the young person. For this reason, we require CIP volunteers to understand that it may be initially difficult for a young person to integrate with a community group. With this in mind, we request volunteers to be patient with, and encouraging of, the young person. Try not to show frustration if things don’t work out. The important thing is that we keep trying.

Are you able to commit to the requirements above?

□ Yes□ No

On-going training

CIP volunteers will be given opportunities for ongoing training. Your CIL will organise this on an as-needs basis. In addition, you are welcome to attend free Mentor Matterstrainingwhich takes placeevery six weeks (training runs on a weeknight for two hours) in metropolitan Melbourne. Gippsland volunteers will be given opportunities to attend training locally. A timetable of training dates will be sent to you. Not all topics will be relevant to your CIP volunteer role but we will inform you about the ones that are of particular interest.

Are you interested in attending ongoing training? □ Yes□ No

Drugs and Alcohol

Are you able to make a commitment not to have any contact with a young person while you are affected by, or consuming, drugs or alcohol?

□ Yes□ No

REFERENCES

Please provide the name and contact details of two people who can act as a referee for you. It is desirable that this person can speak of your involvement with the community. However, if this is not possible, please provide a referee who has been your employer or supervisor.

Your nominated person needs to: have known you for at least 12 months, not be a significant other, have regular contact with you and be able to vouch for you. Please inform your referee that we will be in contact with them. All references are strictly confidential.

First referee:

Name:
Company/Organisation:
Position:
Telephone:
Mobile:
Best time to call:
Is your referee (please tick whichever is applicable):
community person / current employer/supervisor / former employer/supervisor

Second referee:

Name:
Company/Organisation:
Position:
Telephone:
Mobile:
Best time to call:
Is your referee (please tick whichever is applicable):
community person / current employer/supervisor / former employer/supervisor

Please complete this formand contact the Community Integration Leader in your region. Their details are as follows:

Victoria Romeo, North & West Region:0434837854

Email:

Aisha Baker, Southern Region: 0406 839 632

Email:

Teagan Johnson, Gippsland Region: 0421 711 765

Email:

FOR EVALUATION OF COMMUNITY INTEGRATION PROGRAM

Please answer the following questions to help us with the evaluation of the CIP. Your responses will be treated in confidence and stored securely. No names or other identifying information will be included in any report on the CIP.

Name:
Address:
Today’s date:

CHILDREN IN RESIDENTIAL CARE

How are children in residential care different to children who live with their families?

What barriers do children in residential care face that children living with their families generally don’t?

How did you find out about the CIP?

Thank you for the time you have taken to answer these questions.

CIP Volunteer ApplicationPage 1 of 5Issue date: 09/01/15