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COC Thailand Volunteer Application Form
Personal Details
Name
(required)
Address
(required)
City
(required)
State
(required)
Zip Code
(required)
Country
(required)
Email
(valid email required)
Phone Number
Date of Birth
(required)
Gender
(required)
Marital Status
(required)
Do you have a current passport?
Nationality
(required)
Passport Number
(required)
Place of issue
(required)
Date of Expiry
(required)
Are you blacklisted in any country?
If Yes, Why?
Over the last 5 years have you been investigated, involved with, charged or convicted regarding: Drugs Child Abuse/Molestation, Sexual Immortality or Homosexualuty;
If Yes Please attach a separate sheet with details
Qualifications & Employment
Qualifications/Certificates
(required)
Present Occupation
(required)
Languages spoken
(required)
Trades/Practicle skills
Computer skills
Other skills/abilities
Employment History (for the last 5 years)
Employer
Responsibilities
Length Of Employment
Referee's / Reference
Name
e-mail
Phone Number
Relationship to Applicant
Name
e-mail
Phone Number
Relationship to Applicant
Name
e-mail
Phone Number
Relationship to Applicant
Church Information
Church You Attend
(required)
Period of Attendence
(required)
Address
(required)
City
(required)
State
(required)
Zip Code
(required)
Country
(required)
Postition Held in Church
(required)
Name of Pastor
(required)
Year of Salvation
(required)
Year of H/S Baptism
(required)
Do you tithe to your church
Briefly Outline you ministry involment with your current church
(required)
Previous Outreach Experience (Include dates, places and with whom)
(required)
Medical History
List any physical disabilities or ailments
Are you currently taking medication for any medical conditions?
If yes, please state the condition and the medication
Do you or have you ever suffered from any of the following conditions?
Diabetes
Asthma/COPD
Headaches/Migraines
Stroke
AMI(Heart attack)
Neurological Disorder
Hypertension
Kidney Disease
Other Heart Condition
Arthritis
Thyroid Disease
Heamotological Condition
HIV
Hepatitis (B,C,D)
What is your Blood Group
Allergies
If Yes Please State:
Other Medical Conditions
PLEASE NOTE: Answering Yes to any of these conditions will not necessarily prevent you from being accepted.
Other Relevant Information
In which country are you desiring to
serve
(required)
What date/month would you be looking at arriving
Intended Length of Stay
State your financial ability to cover the cost of your trip
Explain in 50 words or more why you desire to volunteer at COC Thailand or The
Haven
Project:
What do you consider to be your main strengths:
What do you consider to be your main weaknesses:
Confidential Section
Over the last 5 years have you been investigated, involved with, charged or convicted regarding: Drugs Child Abuse/Molestation, Sexual Immortality or Homosexuality.
If Yes , please provide details:
As you will be working with children, we request that you provide us with a copy of a current police clearance and the relevant Child Protection / Working With Children Clearance from your country / state.
If you cannot provide, please give details as to why:
The COC Thailand & The Haven Project Volunteer Application Declaration
I, the person named in, and signatory to the application, do declare that the above information is true and accurate.
If selected to be a Member of the COC Thailand or The Haven Project Team, I agree:
1. To obey all instructions of the appointed supervisor
2. To receive, or be current on the following vaccinations: Hep A, Hep B, Thyphoid, Polio, Adult Diptheria & Tetanus, MMR (measles, mumps and rubella).
3. I have been informed that the following vaccinations are recommended: Malaria Prophylaxis, Rabies, Japenese Encephalitis, Cholera, and that these may be compulsory for certain countries/or projects.
4. To show proof of Travel Insurance Documents.
5. Not to enter into private arrangements to visit on subsequent trips, with persons, churches, or contacts previously established by COC Thailand or The Haven Project without the consent of the Haven Project or COC Thailand National Office.
6. Not to correspond with any of the contacts or children I meet with on this trip, except via the volunteer coordinator. This includes via email, written letter, phone and social media facillities such as Facebook,MySpace etc.
7. I will not hold COC Thailand, The Haven Project, or it's staff or representatives legally responsible for any incidences or injuries which may occur during my approved time with the Haven Homes.
8. Upon my arrival I will sign the Intellectual Property Protection
Contact
and Confidentiality Agreement.
Name
(valid email required)
Signature Field
(required)
Date of Signature
(required)
Before you Submit your application please ensure you have:
1. Answered all questions clearly and accurately
2. Attached a recent passport size photo of yourself (in the space provided at the top of the document).
3. Requested references from your Pastor and Referees to be filled out and returned by email or post.
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