RSPCA Darwin Regional Branch
Animal Ambulance Driver Form - RSPCA Darwin Regional Branch
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Animal Ambulance Driver
ABOUT YOU
First Name
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Surname
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Preferred Name
Address
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Mobile Phone
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Other Phone
Email Address
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Date of Birth
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MM slash DD slash YYYY
NEXT OF KIN
Name of Emergency Contact
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Phone Number
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Relationship with the Volunteer
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VOLUNTEERING
Tell us what motivated you to volunteer at the RSPCA Darwin
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Have you previously volunteered with RSPCA ?
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Yes
No
Interstate or Overseas
Your work status
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Student
Fulltime work
Part time work
Retired
FIFO
Not employed
Other
Profession
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Have you visited the RSPCA Darwin shelter?
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Yes
No
What were your top 2 impressions of the shelter?
Are there any limitations, medical conditions or medications you are taking that we should be aware of or may interfere with your ability to perform the tasks?
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Yes
No
Please provide details
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Do you have a current Police Clearance Certificate?
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Yes
No
Do you agree, while at or representing RSPCA Darwin, to adhere at all times to our policies, procedures, and values, and not express opinions that are not in line with RSPCA values or positions?
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Yes
No
All volunteers are required to be easily identifiable while working at or representing RSPCA Darwin. You may either wear a vest, that can be worn over top of your own clothing and is washed by RSPCA at the end of your shift, or you may purchase your own branded quality polo shirt that can be embroidered with your name (please note that you will need to cover the cost of the t-shirt of $35).
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I will wear the on-site vests over my own clothing, and leave it at the shelter each shift for washing
I would like to order a branded polo shirt
Size
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--- Select ---
S
M
L
XL
Name to be embroidered
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When are you available for an induction?
Select Induction Dates
11 October 2018
27 October 2018
8 November 2018
24 November 2018
6 December 2018
10 January 2019
19 January 2019
7 February 2019
23 February 2019
Are you seeking to use volunteering as part of a formal work experience or work-related program in which you will require supervision, tasks signed off, dates or activities signed off or any other formal documentation?
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Yes
No
Please give details of your course or program, and the requirements from RSPCA
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--- Select ---
Certificate in animal care
Veterinary nursing qualification
Workplace injury/insurance or subsidized volunteering
Government / employment services volunteering
Corporate volunteering
Defense force volunteering
Other
Please give details of your course or program, and the requirements from RSPCA
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Driver’s license / ID document
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Max. file size: 80 MB.
Upload resume (optional)
Max. file size: 80 MB.
Do you have experience handling animals, including dogs and cats that may be boisterous, scared or may be less confident being handled?
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Yes
No
Please describe
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Do you have a manual driver’s license?
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Yes
No
Do you have a clean driving record?
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Yes
No
Please describe
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Are you willing and able to lift animals into the vehicle on some occasions?
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Yes
No
Are you able to commit to a minimum of one shift per week
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Yes
No
Please describe
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Are you able to commit for a minimum of 6 months?
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Yes
No
Please describe
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Please tick which times you are available to commit to a regular scheduled shift
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Monday to Friday 8.30-9.30am
Monday to Friday 3-4pm
Seven days a week minus Sunday afternoon
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