In order for St John Ambulance Australia (NT) Inc. to maintain safety for its members & community we require a valid National Police Check & Working with Children’s Card. Applicant Details Title Full Name Preferred Name Date of Birth Gender - None - Male Female Other Home Address Postcode Postal Address Postal Postcode Email Address Contact Number Occupation Unique Student Identifier (USI) Number Previous Volunteering/Employment with St John Please provide details if applicable Emergency Contact Details Full Name Relationship Contact Number Email Residential Address Current Certifications If you currently hold any of the below, please provide copies NT Working with Children Clearance (Ochre Card) National Police Clearance NT Driving Licence (C Class) Immunisation Record Provide First Aid Provide Advanced First Aid Provide Advanced Resuscitation AHPRA Registration Copies Unlimited number of files can be uploaded to this field.5 MB limit.Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods. Commitments I, hereby acknowledge as a volunteer member with St John Ambulance Australia (NT) Inc.If you currently hold any of the below, please provide copies, I shall:Abide by current St John Ambulance Australia (NT) Inc. Policies, Procedures, and Code of Conduct.Continually maintain or update my skills and knowledge in First Aid, and Child Safeguarding practices.Hold a valid NT Working with Children Clearance.Present a positive image of St John Ambulance Australia (NT) Inc. to the community.Undertake a National Police Clearance.Complete a three (3) month probationary period.Notify St John Ambulance Australia (NT) Inc. immediately of the suspension of my National Police Clearance, Working with Children Clearance, Driving License or any breach of Policies, Procedures or Code of Conduct.Return all Personal Protective Equipment (PPE), Uniforms, and Identification Cards issued upon my resignation. I acknowledge and agree to abide by the above statements. Child Safeguarding:St John Ambulance Australia (NT) Inc.Recognises that children have rights as individuals and should be treated with dignity and respect.Believe that children have the right to always be emotionally and physically safe.Will take all reasonable precautions to protect children in its care from harm of every kind.Ensure that all adult members are aware of their child safeguarding responsibilities.Co-operates with government child safeguarding agencies. I acknowledge and agree to abide by the above statements. Medical Questionnaire Do you have any medical conditions which may affect you volunteering? If yes, please specify Do you have any allergies? If yes, please specify References Please supply two referee’s and one must be an employer Reference 1 Name Reference 1 Phone Reference 1 Email Reference 2 Name Reference 2 Phone Reference 2 Email Where did you hear about us? Referral Source First Aid Training Course Facebook Instagram Newspaper Radio Other Department within St John NT Word of Mouth Other Other Referral Source Declaration Full Name I hereby declare that all the information I have supplied in this application is correct and understand that any false declarations made above will invalidate my application. Signature Sign above
