9 - Esperance Volunteer Resource Centre - Web Forms

Volunteer Form

More information on Volunteering here - *read this information before filling out a form

Volunteer Registration Form - Fill out if you'd like some guidance on where to volunteer!

Title*This field is required.

* Required Field.

First Name*This field is required.

* Required Field.

Surname*This field is required.

* Required Field.

Address

Street Address:*

* Required Field

City:*

* Required Field

State:*

* Required Field

Post Code:*

* Required Field

Country:*

* Required Field

Phone Number*This field is required.

* Required Field.* Not vaild

Email*This field is required.

* Required Field.* Not vaild

Gender

Date of Birth*This field is required.

* Required Field.

Have you volunteered before?*This field is required.

YesNo

* Required Field.

Would you like to receive emails regarding future volunteer opportunities?*This field is required.

YesNo

* Required Field.

Your previous work experience relevant to Volunteer Interests:

What skills would you like to develop?*This field is required.

* Required Field.

Is there any work you are unable to do? If so, please write here.*This field is required.

* Required Field.

Do you have any of the following?*This field is required.

National Police Clearance
Working With Children Check
C Class License
Medical Check
LR Class Licence
Traffic Check
First Aid
None
Other (please specify below):

Other (from question above):

Which of the above that you don't have, are you happy to obtain if needed?*This field is required.

* Required Field.

Can you do heavy lifting? (>10kg)*This field is required.

YesNo

* Required Field.

Do you identify as having a disability?*This field is required.

YesNo

(if yes, please specify).:

* Required Field.

Will you be volunteering with a carer / support worker?*This field is required.

YesNo

* Required Field.

Available for:*This field is required.

General VolunteeringSpecial Events VolunteeringEmergency Response Volunteering

How did you hear about us?

What is your country of birth?*This field is required.

* Required Field.

Do you identify as Aboriginal, Torres Strait Islander, Both or Neither?*This field is required.

AboriginalTorres Strait Islander
BothNeither

Are you from a non-english speaking background?*This field is required.

YesNo

If yes, what is your first language?:

* Required Field.

Current work status?*This field is required.

Full TimePart Time } Casual
UnemployedRetired

Are you volunteering as part of a Centrelink obligation?*This field is required.

YesNo

* Required Field.

Availability?*This field is required.

Monday AMMonday PM
Tuesday AMTuesday PM
Wednesday AMWednesday PM
Thursday AMThursday PM
Friday AMFriday PM
Saturday AMSaturday PM
Sunday AMSunday PM

Looking to commit how many hours per day / week / fortnight / month to volunteering?*This field is required.

* Required Field.

What type of activities would you like to do in your volunteer work?*This field is required.

Accounting & Finance
Administration & Office Management
Arts, Craft & Photography
Childcare
Companionship & Social Support
Disability Support
Driving & Transportation
Education & Training
Food Preparation & Service
Fundraising & Events
Garden Maintenance
Governance, Boards & Committees
IT & Web Development
Library Services
Marketing, Media & Communications
Mediation & Advocacy
Music & Entertainment
Research, Policy & Analysis
Retail & Sales
Safety & Emergency Services
Seniors & Aged Care
Sport & Physical Activity
Tour Guides, Information & Heritage
Trades & Maintenance
Translation & Interpreting
Tutoring & Coaching
Working with Animals
Writing & Editing
Other: (please specify below)

Other (from question above):

What causes would you like to support?*This field is required.

Animal Welfare
Arts & Culture
Community Services
Disability Services
Disaster Relief
Drug & Alcohol Services
Education & Training
Emergency Response
Environment & Conservation
Family Services
Health
Homeless
Human Rights
Indigenous Australians
Mentoring & Advocacy
Migrant Services
Museums & Heritage
Recreation
Seniors & Aged Care
Sport
Veteran Services
Young People
Other (please specify below)

Other (from question above):

Any further notes?

You may be contacted in the coming months to seek your opinion of the standard of service you have received from us and to follow up on your progress into volunteering. I authorise the Esperance Volunteer Resource Centre to release my information to member organisations in order to obtain a volunteer position, and give consent to my details being entered into database/s to be used for statistics and volunteering related purposes.*This field is required.

YesNo

* Required Field.

Are you under 18?*This field is required.

YesNo

* Required Field.

If you are under 18, you must have permission from your parent or guardian to submit this volunteer registration form. You must also have their consent for the Esperance Volunteer Resource Centre to share your details with volunteer-involving organisations in Esperance. Ticking yes indicates that you have a guardian's permission.

YesNo

If you are under 18, what is your guardian's full name and contact number?

Your Signature*This field is required.

* Required Field.

Date*This field is required.

* Required Field.

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Organisation Forms

More information on Organisations and which forms to fill out here - *read this information before filling out a form

Agency Membership Form

Agency Name*This field is required.

* Required Field.

Agency ABN*This field is required.

* Required Field.* Not vaild

Email*This field is required.

* Required Field.* Not vaild

Phone*This field is required.

* Required Field.* Not vaild

Physical Address

Street Address:*

* Required Field

City:*

* Required Field

State:*

* Required Field

Post Code:*

* Required Field

Country:*

* Required Field

Mailing Address - Same as street address?*This field is required.

YesNo

If no, what is your Mailing Address?:

* Required Field.

Description of Agency*This field is required.

* Required Field.

Incorporated?*This field is required.

YesNoUnsure

Volunteering Roles Offered*This field is required.

* Required Field.

Number of Current Volunteers*This field is required.

* Required Field.* Not vaild

Number of Current Paid Staff*This field is required.

* Required Field.* Not vaild

Agency is a Centrelink Approved Organisation?*This field is required.

YesNo

If yes: Centrelink number?: *

* Required Field.

Would you like information and/or assistance with any of the following? Please tick.*This field is required.

Volunteer Recruitment
The National Standards for Volunteer Involvement
Policies & Procedures
Volunteer Recognition
Writing Volunteer Position Descriptions
Risk Management
Inclusion & Diversity
Emergency / Event Volunteering
Exiting Volunteers
None
Other: Please specify below

Other (from question above):

Service Focus*This field is required.

Animal Welfare
Disability Services
Education & Training
Family Services
Human Rights
Migrant Services
Seniors & Aged Care
Young People
Arts & Culture
Disaster Relief
Emergency Response
Health
Indigenous Australians
Museums & Heritage
Sport
Community Services
Drug & Alcohol Services
Environment / Conservation
Homeless
Mentoring & Advocacy
Recreation
Veteran Services
Other: Please specify below

Other (from question above):

Public Liability Insurance: Policy Number*This field is required.

* Required Field.

Public Liability Insurance: Policy Expiry Date:*This field is required.

* Required Field.* Not vaild

Public Liability: Insurance Company*This field is required.

* Required Field.

Have you emailed a copy of your Public Liability Insurance Policy to volunteer@esperance.wa.gov.au ?*This field is required.

YesNo

If no, when will you email it to us? Our funding requires agencies to have Public Liability Insurance before we are able to refer volunteers to them.: *

* Required Field.

Volunteer Personal Accident Policy Number:*This field is required.

* Required Field.

Volunteer Personal Accident Policy Expiry Date:*This field is required.

* Required Field.

Volunteer Personal Accident Policy: Insurance Company*This field is required.

* Required Field.

Have you emailed a copy of your Volunteer Personal Accident policy to volunteer@esperance.wa.gov.au ?*This field is required.

YesNo

If no, when will you email it to us? Our funding requires agencies to have Volunteer Personal Accident Insurance before we are able to refer volunteers to them.: *

* Required Field.

Volunteer Coordinator Name*This field is required.

* Required Field.

Volunteer Coordinator Job Title*This field is required.

* Required Field.

Contact Phone*This field is required.

* Required Field.* Not vaild

Contact Email*This field is required.

* Required Field.* Not vaild

Preferred Contact Method

Phone
Email

Subscribe to Esperance Volunteer Resource Centre Email List*This field is required.

YesNo

* Required Field.

Agency Representative Name*This field is required.

* Required Field.

Agency Representative Job Title*This field is required.

* Required Field.

Signature*This field is required.

* Required Field.

Date*This field is required.

* Required Field.

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Request for Volunteers Form

Agency Name*This field is required.

* Required Field.

Volunteer Coordinator*This field is required.

* Required Field.

Contact Number*This field is required.

* Required Field.* Not vaild

Email*This field is required.

* Required Field.* Not vaild

Service Focus*This field is required.

* Required Field.

Volunteer Position Name*This field is required.

* Required Field.

Number of volunteers required*This field is required.

* Required Field.* Not vaild

Type of role*This field is required.

General VolunteeringSpecial EventEmergency Response

Short Description of Role (brief, catchy overview)*This field is required.

* Required Field.

Detailed Description (What will the volunteer be doing? Outline specific tasks, time commitments & any reimbursements offered).*This field is required.

* Required Field.

Physical Location of Role*This field is required.

* Required Field.

Urgent*This field is required.

YesNo

* Required Field.

Role Expiry Date (if there isn't one, write 'none')*This field is required.

* Required Field.

Suitable For*This field is required.

Wheelchair Access
Younger Volunteers (14-19 years)
Centrelink Volunteers
Online & Remote Volunteers
Families with Young Children
People with Disabilities
People Learning English
Volunteers with a Support Worker
None of the Above
Other (please specify below)

Other (from question above):

Would you like information/assistance on how to adapt roles to be more inclusive?*This field is required.

YesNo

* Required Field.

Clearances / Licences Required for the Role*This field is required.

National Police Clearance
Working With Children Check
C Class License
Medical Check
LR Class Licence
Traffic Check
None
Other (please specify below):

Other (from question above):

Any further requirements for Volunteers to undertake this role?*This field is required.

* Required Field.

Training Provided by Agency?*This field is required.

YesNo

If 'yes', which types? If 'no', any comments/?:

* Required Field.

Possible Restrictions*This field is required.

Heavy LiftingWorking above shoulder heightExtended Standing TimeNone

Age Range (please check insurance restrictions)*This field is required.

* Required Field.

Working Environment*This field is required.

AloneWith OthersAlone & With Others

Required Availability (Write days and times for each day)*This field is required.

* Required Field.

Work Categories*This field is required.

Accounting & Finance
Administration & Office Management
Arts, Craft & Photography
Childcare
Companionship & Social Support
Disability Support
Driving & Transportation
Education & Training
Food Preparation & Service
Fundraising & Events
Garden Maintenance
Governance, Boards & Committees
IT & Web Development
Library Services
Marketing, Media & Communications
Mediation & Advocacy
Music & Entertainment
Research, Policy & Analysis
Retail & Sales
Safety & Emergency Services
Seniors & Aged Care
Sport & Physical Activity
Tour Guides, Information & Heritage
Trades & Maintenance
Translation & Interpreting
Tutoring & Coaching
Working with Animals
Writing & Editing
Other (please specify below)

Other (from question above):

Any notes or questions

Signature*This field is required.

* Required Field.

Date*This field is required.

* Required Field.* Not vaild

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Training Request Form

Name*This field is required.

* Required Field.

Email*This field is required.

* Required Field.* Not vaild

Phone*This field is required.

* Required Field.* Not vaild

Are you volunteering for or involved in a certain organisation/board/committee in Esperance?

YesNo

Write the Name of your Organisation: *

What topic/specific issue would you like the training to focus on?*This field is required.

* Required Field.

List 1-3 outcomes you would like from this training

Should this training be designed for:

VolunteersVolunteer ManagersBoard/Committee Members

Do you know of anyone else interested in attending this training?

Preferred days/times of the training?

Level of training required

BeginnerIntermediateAdvancedREFRESHER

Do you have a preferred training provider in mind? If yes, please specify

Any additional comments or suggestions?

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Equipment Hire Form

More information on our Equipment Hire here - *read this information before filling out a form

Equipment Hire Request Form

Name*This field is required.

* Required Field.

Organisation / Company Name if applicable

This hire is for:*This field is required.

* Required Field.

If this hire is for an Individual or For-Profit Business, fees apply. These are viewable in our fee document on our Equipment Hire Page. Please write 'Yes' below to confirm that you are aware of the costs involved and agree to pay if your hire is confirmed (we will contact you for invoice details).

Phone*This field is required.

* Required Field.

Email*This field is required.

* Required Field.* Not vaild

Reason for Hire - e.g. Event, workshop, etc.*This field is required.

* Required Field.

Location the items will be stored*This field is required.

* Required Field.

Preferred Collection Date:*This field is required.

* Required Field.

Preferred Collection Time*This field is required.

* Required Field.

Preferred Return Date*This field is required.

* Required Field.

Preferred Return Time*This field is required.

* Required Field.

Electronic: Please tick the items that you would like to hire

1 x J.Burrows MG100 Megaphone with Detachable Microphone
Laptop – Dell Latitude 3540
Projector - Epson EB-1795F
Projector – Epson EB-1781W
Projector - Epson EB-1735W
Projector – NEC VT695
Projector Screen (our biggest one) Pull-up screen. Top to bottom: 2.008m, Screen width: 1.72m, Screen height: 1.07m
Projector Screen (our smallest one) On a tripod. Top to bottom: 1.94m, Screen width: 1.44m, Screen height: 0.81m
PA Speaker VONYX VSA Series (has 1 x headset microphone and 1 x hand-held one (both wireless)
PA Speaker MIPRO MA-708 (has 1 x bluetooth & 1 x cabled microphone)
Portable JBL Bluetooth Speaker
Festoon lights (4.5M) #1
Festoon Lights (4.5M) #2
Fairy Lights tub #1
Fairy Lights tub #2

Signage: Please tick the items that you would like to hire

3 x Blue Velcro Pin-Up Boards (with stands)
1 x Black Velcro Pin-Up Board (with stand) 2m tall x 2.6m wide
A-Frame Chalkboard x 2 (writing area size: W435xH580mm)
6 x Small Blackboards

Heavy Duty : Please tick the items that you would like to hire

4 x Folding Trestle Table - Small (60cm wide x 120cm long)
1 x Folding Trestle Table - Large (75cm wide x 180cm long)
2 x Non-folding Trestle Table - Large
Rainbow Marquee (heavy duty) #1
Rainbow Marquee (heavy duty) #2
3 x Side Walls for Rainbow Marquee #1
3 x Side Walls for Rainbow Marquee #2
Oztrail 3m Hydroflow Gazebo – Grey - Weighs 24.5kg #1
Oztrail 3m Hydroflow Gazebo - Grey - Weighs 24.5kg #2
3 x Solid Walls for Oztrail Hydroflow Gazebo #1
3 x Solid Walls for Oztrail Hydroflow Gazebo #2
4 x Base Pods for Oztrail Hydroflow Gazebo #1
4 x Base Pods for Oztrail Hydroflow Gazebo #2
Toplift Folding Hand Trolley – 150KG max
Folding Hand Trolley – Saxon brand. 160KG max
Saxon Platform Trolley - 150kg Max
20 x Black Foldable Chairs
4 x Green Plastic Chairs
1 x Fellowes Pulsar Binding Machine

Hospitality: Please tick the items that you would like to hire

Hot Water Urn (8.8L)
2 x Glass Drink Dispensers (4L each)
28 x Mugs
45 x Tea Cups with 16 x Saucers
11 x Tea Cups with 15 x Saucers
6 x Platters #1
6 x Platters #2
10 x large platters
7 x Serving Bowls #1
7 x Serving Bowls #2
Food Storage Box 29 x 45cm
2 x Blue Plastic Water Jugs
2 x Glass Water Jugs (1.8L each)
65 x Red Volunteer Kitchen Aprons
1 x 42L Grey Flexi Round Tub (can be used for ice & cold drinks)
2 x 60L Grey Flexi Round Tub (can be used for ice & cold drinks)

Other:

25 x White Buckets with Handles (for beach clean ups)
3 x Hula Hoops (can be used for rubbish sorting when doing beach clean-ups)
12 x Red Bucket Hats with EVRC old logo on them. Size L/XL kids
Cash Box

Any notes or questions?

Do you understand that by submitting this form, your hire is NOT confirmed until you receive a confirmation email from us?*This field is required.

YesNo

* Required Field.

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Event RSVP's

Forms will be shown below when we have upcoming events.

Volunteer Form

Volunteer Registration Form - Fill out if you'd like some guidance on where to volunteer!

Organisation Forms

Agency Membership Form

Request for Volunteers Form

Training Request Form

Equipment Hire Form

Equipment Hire Request Form

Event RSVP's

*example event here*

Subscribe to our e-newsletter

example event here