Applicant Details Title - Select - Mr Mrs Ms Miss Dr Other Full Name Preferred Name Date of Birth Gender - Select - Male Female Other Home Address Postcode Postal Address Leave blank if same as home address Postcode Contact Number Occupation Unique Student Identifier (USI) Number What school do you attend? Are you Aboriginal or Torres Strait Islander? Aboriginal Torres Strait Islander No Emergency Contact Details (Parent/Guardian) Full Name Relationship Contact Number Residential Address Email Current Qualifications If you currently hold any of the below, please provide copies (may not be relevant to all) NT Working with Children Clearance (Ochre Card) (If 15 years or older) NT Driving Licence (C Class) Immunisation record Provide First Aid Provide Advanced First Aid Provide Advanced Resuscitation Files 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. Acknowledgement I hereby acknowledge as a volunteer member with St John Ambulance Australia (NT) Inc. 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. At 15 years or older, hold a valid NT Working with Children Clearance. Present a positive image of St John Ambulance Australia (NT) Inc. to the community. Notify St John Ambulance Australia (NT) Inc. immediately of the suspension of 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 from St John Ambulance Australia (NT) Inc. I acknowledge the above conditions 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. Medical Questionnaire Do you have any medical conditions which may affect you volunteering? If yes, please complete Youth Health Declaration - None - Yes No Do you have any Allergies? If Yes, Please Specify Code of Conduct As a member of St John Ambulance, a certain standard of behaviour is expected of you. Your actions reflect on St John NT. This agreement is between you, (Member) and St John Ambulance Australia (NT) Inc. A copy of the Code of Conduct is available. I hereby, understand and agree to abide by the Code of Conduct. I understand actions will be taken if I do not conduct myself by this code at all times. Any discipline taken will be in accordance with St John Ambulance Australia (NT) Inc policy and procedure. I have read and understand the St John Ambulance Code of Conduct Declaration 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. Full Name (Guardian) Required if applicant is under 18 Signature If under 18 years Guardian signature Where did you hear about us? Please select all that apply First Aid Training Course Facebook Instagram Newspaper Radio Other Department within St John NT Word of mouth Community Education Other If Other, please specify
