VOLUNTEER APPLICATION FORM
Name (as in NRIC / Passport): (Dr / Mr / Mrs / Ms / Mdm)
NRIC/Passport No.: Date of Birth: Nationality: Race:
Address: Singapore
Mobile No.: Home Tel: Email:
Maritial Status: Religion: Church Attending:
Occupation: Student (Name of school / institution attending: ______________________________________)
Recent Graduate (Name of school / institution graduated from: _________________________________)
Retiree or homemarker (Job / work background: __________________________________________________)
Working professional (Company & job function / designation: _____________________________________)
Others (Please specify: ________________________________________________________)
Languages/ Dialects Spoken:
Languages Written:
Commitment of Volunteer Service Availability (please tick)
[ ] 6 months Mon Tue Wed Thu Fri Sat Sun
[ ] 1 year 9am - 1pm:
[ ] Others: _______________ 1pm - 5pm:
Interested Areas of Volunteering:
[ ] Befriending [ ] Meal Server [ ] Others __________________
Area of talents (if any): _______________________________________
Declarations
Medical Record:
Are you suffering from or have you ever suffered any physical impairment or disease including mental
illness, deafness, handicap, etc? * Yes / No
Criminal Record:
Have you ever been arrested, indicted, or summoned into court as a defendant in a criminal proceeding,
or convicted, fined, or imposed for the violation of any law (excluding minor traffic violations)? * Yes / No
* If "yes", please provide details:
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
Your Emergency Contact
Contact Person: Tel: Relationship with you:
Address:
(if not the same as your own)
Statement of Understanding
I hereby declare that the information furnished on this application is true and accurate. I consent to having my personal data recorded in
the relevant database(s) of St. Andrew’s Senior Care; to be contacted by St. Andrew’s Senior Care’s relevant departments, and to
accept St. Andrew’s Senior Care’s decision on my application to be a volunteer.
Signature: __________________________________________ Date: _______________________
For Pastoral Care Volunteers Application
Statement of Support from Vicar / Pastor of Church
(applicable for pastoral care volunteers only)
I give my support for my church member, __________________________________________________ to volunteer
(church member's full name)
and serve at St. Andrew's Senior Care (Tampines)’s in the area of Pastoral Care.
Name: __________________________________
Church:
__________________________________
Signature Church Stamp Date
Tel:
__________________________________
For Official Use Only
Assessment (For official use only)
Interviewed by: Date:
Volunteer Placement & Day: Tentative Commencement:
Other Remarks:
