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 Suburb Postcode Postal Address If different to home address. Postal Postcode Email Address Contact Number Are you Aboriginal or Torres Strait Islander? Aboriginal Torres Strait Islander No Previous Volunteering/Employment with St John Please provide details if applicable Occupation Unique Student Identifier (USI) Number 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. Agreements As a volunteer member with St John Ambulance Australia (NT) Inc., I shall:Present a positive image of St John Ambulance Australia (NT) Inc. to the community.Maintain and update my skills and knowledge in First Aid and Child Safeguarding practices as required.Hold a valid Northern Territory Working with Children Clearance (Ochre Card) and provide a copy.Undertake and provide a current National Police Clearance.Complete a three (3) month probationary period.Immediately notify St John Ambulance Australia (NT) Inc. of any suspension, cancellation or changes to my: National Police Clearance, Working with Children Clearance, Driver's Licence.Return all Personal Protective Equipment (PPE), uniforms and identification cards issued to me upon resignation or termination of my volunteer role. I agree to abide by the above statements. Child Safeguarding:St John NT has zero tolerance for child abuse.St John Ambulance Australia (NT) Inc. is committed to the safety and wellbeing of all children and young people who participate in our activities, programs, events, services and patient care.We want children to be safe, support, nurtured and empowered while involved in our programs and being cared for by our people. We will take a preventative, proactive and participatory approach to child safety.This commitment includes:Providing a child safe environment.Valuing the input of parents, guardians or carers.Respecting culturally and/or linguistically diverse backgrounds.We promise to:foster a culture of openness without fear or repercussions, victimisation or retaliation.provide St John Ambulance Australia (NT) Inc. members with education on child safety.Ask for consent from parents, guardians or carers.St John Ambulance Australia (NT) Inc. Child Safeguarding and Wellbeing Code of Conduct I agree to abide by the above statements in regards to Child Safeguarding. Media Talent Release:St John Ambulance Australia (NT) Inc. may wish to take your photo or interview you for marketing and promotional purposes.Agreeing to the St John Ambulance Australia (NT) Inc. Media Talent Release grants us permission to use any photos, videos, audio recordings, or written information about you for their marketing materials, including on websites, social media or issued to the media. The content may be changed, cropped, or combined with photos of others. You will not be paid for the use of your image, photos, videos or recordings.Permission is optional, your choice will be respected, and you may at any time remove your permission in writing to media@stjohnnt.asn.au. I give my permission and agree to the above Media Talent Release statements. I do not give my permission and do not agree to the above Media Talent Release statements. Code of Conduct:As a member of St John Ambulance Australia (NT) Inc., a certain standard of behaviour is expected of you. Your actions reflect on St John Ambulance Australia (NT) Inc. This agreement is between you, (Member) and St John Ambulance Australia (NT) Inc. St John Ambulance Australia (NT) Inc. Code of Conduct I agree to abide by the above Code of Conduct. 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 referees. One must be your current employer and ensure that either of your referees are not family members.Your referees will be emailed an online survey to complete. Reference 1 Name Reference 1 Email Reference 2 Name 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 CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
