Volunteer Application Form

Kia Ora. Thank you for your interest in Volunteering with Blind Low Vision NZ. To enable us to understand your skills and offer you an appropriate role, please complete all details in this application form below

Prerequisites

From 1 December 2021 all employees, volunteers and contractors working on behalf of Blind Low Vision NZ will need to provide acceptable proof of full Covid-19 vaccination status before engaging with our clients or entering Blind Low Vision NZ offices or worksites. In order to be considered for a Volunteer role, you will need to provide proof accordingly.

I understand

Are you fully vaccinated against Covid-19?

Yes, I'm fully vaccinatedNo, I'm not fully vaccinated

Date of second vaccination or booster

Please enter the date you received either your second Covid-19 dose or an additional Covid-19 booster.

Comments

Unfortunately, we are unable to continue with your application. In order to apply for a Volunteer role, you must be fully vaccinated against Covid-19. You can also call 0800 24 33 33 to speak to one of our helpful staff, who will be able to provide you with more information and assistance.

I understand

Your personal details

Title

First Name

Middle Name

Last Name

Known as

Date of Birth

Your contact details

What is your call preference?

Home Phone (Landline)

Mobile Phone

Work Phone

Your current residential address

Address

Street Address

Suburb

City/Town

Post Code

Region

References

Please give details of two referees who can be contacted (who have preferably known you for more than one year and are not family members).

Reference One

First Name

Last Name

Phone

Reference Two

First Name

Last Name

Phone

Additional Information about you

Are you blind or have low vision?

Yes, I'm blind or have low visionNo, I'm not blind or have low vision

Do you have any mental or physical health issues that may be affected by volunteering, or affect your ability to complete volunteer tasks?

YesNo

If yes, please describe

Have you ever had a criminal conviction?

Yes, I have, or have had a criminal convictionNo, I do not have, and have never had a criminal conviction

If you do have a criminal conviction please explain details?

Your communication preferences

Would you like to receive our volunteer newsletter?

Volunteer Newsletter

Before you submit

Your Rights & Privacy

Declaration

I certify that all information that I have provided to Blind Low Vision NZ is true, accurate and complete. I authorise Blind Low Vision NZ to contact my named referees to seek information from them that may be relevant to my application for voluntary service.

Yes, I acknowledge

I understand that If my volunteer application is successful, Blind Low Vision NZ will have to carry out a mandatory Police Vetting check to further process my application. I will have to provide a filled in and signed copy of the NZ Police Vetting form by email to the local Volunteer Coordinator along with the required identification and that this identification will need to be verified either by a JP or through a virtual meeting with the Local Volunteer Coordinator.

Yes, I acknowledge

I acknowledge that I read and understood Blind Low Vision NZ's Volunteer Agreement and Code of Conduct and will sign a copy of the document shall my application be successful.

Yes, I acknowledge

Prepopulated ContactID

Prepopulated RegistrationID