SCIP Volunteer Assistant Registration Form

To find out about SCIP Programme click here

Volunteering Otago

SCIP Youth Volunteer Assistant Application Form


Fields marked with * are required.

Name: *

Email: *

Date of Birth:

Address:

Phone:

Why are you interested in this position?

What skills/attributes do you offer to this position?

Formal Secondary/Tertiary Educational Qualifications/Courses (with years obtained)

Work Experience: (previous employment, years employed, both paid and unpaid)

Date rangeEmployerPosition
Names of two referees, from whom consent has been obtained, who may be contacted for a confidential reference. Where possible, at least one referee should be able to give work related information.

Referee 1

Name:

Position:

Organisation:

Telephone:

Email:

Referee 2

Name:

Position:

Organisation:

Telephone:

Email:

Are you New Zealand Resident/Citizen or Australian Citizen?
Yes
No

If not do you have a current Work Permit?
Yes
No

Expiry Date

Have you ever been charged with a criminal offence?
Yes
No

If yes, please explain:

I certify that the above information is full and correct. I understand that if any false information is given or any material fact is supressed, I may be disqualified from consideration or, if appointed, I may be dismissed.

Signature of Applicant

Date