CVS Online Application

First Name*
Last Name*
Street/Unit Number*
Street Name*
Suburb*
Home Number
(if you do not enter your home number, please enter either your mobile or work number)
Mobile Number
Work Number
Email Address
Re-enter Email Address
How Did You Hear About Us*	Please Select Local Newspaper Ad Other Volunteer Family/Friends Referred via other CVS auspice Volunteer Resource Centre Newspaper Article/Ad Internet Site Expo Other
If you selected "other" please state where you heard about us
Best time to contact you*	Please Select 1:00 2:00 3:00 4:00 5:00 6:00 7:00 8:00 9:00 10:00 11:00 12:00 Please Select AM PM
On what number*	Please Select Home Number Work Number Mobile Number
What suburb would you be prepared to visit in*
Are you over 16 years of age*	Yes No
Are you aware and do you agree to undergo a National Criminal History Record Check as required by the Australian Government (please refer to About Community Visitors Scheme page) in order to volunteer for the CVS program? The cost of the National Criminal History Check is covered by MS Australia - ACT/NSW/VIC*
Yes I am prepared to have a National Criminal History Record Check. No I am not prepared to have a National Criminal History Record Check Comments:
Are you aware and do you agree as required by the Australian Government that a person who has been a citizen or permanent resident of a country other than Australia, since turning the age of sixteen, must sign a Statutory Declaration stating that they have never been convicted of an offence? (please refer to About Community Visitors Scheme page)*
Yes I will sign a Statutory Declaration No I will not sign a Statutory Declaration Comments:
Are you able to give a commitment of 12 months to this program?*	Yes No
* denotes a required field