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Volunteer Application Form
All fields with a “*” are required to be completed. Cut-off dates are: February 15th (term 1 volunteers)- June 15th (term 2 volunteers) and September 15th (term 3 volunteers)
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Personal Information
*First Name:
*Surname:
*ID Number:
*Date of Birth:
*Home Address:
*Email:
*Contact Number:
Alternate Contact Number:
*Emergency Contact Person:
*Emergency Contact Number:
Relationship:
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Languages
Please select your proficiency for each language
English:
Spoken:
Not Applicable
Poor
Average
Good
Written:
Not Applicable
Poor
Average
Good
Afrikaans:
Spoken:
Not Applicable
Poor
Average
Good
Written:
Not Applicable
Poor
Average
Good
Ndebele:
Spoken:
Not Applicable
Poor
Average
Good
Written:
Not Applicable
Poor
Average
Good
Sepedi:
Spoken:
Not Applicable
Poor
Average
Good
Written:
Not Applicable
Poor
Average
Good
Sesotho:
Spoken:
Not Applicable
Poor
Average
Good
Written:
Not Applicable
Poor
Average
Good
South African Sign Language (SASL):
Spoken:
Not Applicable
Poor
Average
Good
Written:
Not Applicable
Poor
Average
Good
Swati:
Spoken:
Not Applicable
Poor
Average
Good
Written:
Not Applicable
Poor
Average
Good
Tsonga:
Spoken:
Not Applicable
Poor
Average
Good
Written:
Not Applicable
Poor
Average
Good
Tswana:
Spoken:
Not Applicable
Poor
Average
Good
Written:
Not Applicable
Poor
Average
Good
Venda:
Spoken:
Not Applicable
Poor
Average
Good
Written:
Not Applicable
Poor
Average
Good
Xhosa:
Spoken:
Not Applicable
Poor
Average
Good
Written:
Not Applicable
Poor
Average
Good
Zulu:
Spoken:
Not Applicable
Poor
Average
Good
Written:
Not Applicable
Poor
Average
Good
Other:
Spoken:
Not Applicable
Poor
Average
Good
Written:
Not Applicable
Poor
Average
Good
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Why should we accept you?
Tell Us About Your Qualifications:
Hobbies and Interests:
Why would you like to volunteer at Friends of Valkenberg?
What can you offer the patients?
*Previous Volunteer Experience:
Where You Worked:
Period/Duration:
Number of hours / week:
What did you do?
*Provide us with a brief reflection on your experience working in the settings listed above (no more than 300 words):
*How do you understand the ways in which your life history and experiences have shaped who you are today and your deeper, more personal motivations for wanting to volunteer at Friends of Valkenberg / Valkenberg Hospital? Use the space provided below. (No more than 300 words):
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When Can You Come?
*Availability:
3 weeks – 5 months
6 months – 1 year
1 year+
*Time Start:(Ony open from 10AM to 12PM)
*Time End:(Ony open from 10AM to 12PM)
*Will you attend quarterly meetings @ 10am on the 1st Monday of the month:
Yes
No
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Health Information
*Do you have any physical problems or illnesses we should know of?
*Have you received any psychiatric or psychological help?
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References
*Reference Name 1:
*Reference Contact Number 1:
*Reference Email 1:
Organization Relationship 1:
Reference Name 2:
Reference Contact Number 2:
Reference Email 2:
Organization Relationship 2:
By checking the box, you agree to the company collecting, storing, and using your personal information in accordance with the Protection of Personal Information Act (POPIA). You acknowledge reading and understanding the terms and conditions of our privacy policy. You can withdraw consent at any time. Your consent authorizes the company to process your personal data for legitimate purposes, including customer support, marketing communications, order processing, and product improvement.
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Submit Application
