CVS - Application Form

Thank you for your interest in the Community Visitors Scheme. Please complete the form below to apply for the Community Visitor role.

Alternatively, if you prefer to submit your application by mail, you can download the pdf file below:

Application Form

Mail to:
Multiple Sclerosis Limited
Community Visitors Scheme
CVS Recruitment
Reply Paid 74656
BLACKBURN, Victoria 3130

Personal Information

Title:

Family Name:

Given Name:

Street Address:

Suburb:

Postcode:

Phone:

Home Work Mobile

Email:

Locations

If you're living in Melbourne/Sydney, which suburbs would you prefer to visit?

If you're living in regional Victoria, which towns would you prefer to visit?

What is your preferred method of transport to the Aged Care Home? Car Public transport Biking Walking

Eligibility Questions

Are you over 16 years of age? Yes No

Are you legally entitled to work/volunteer in Australia? Yes No

Do you have any restrictions on your right to work/volunteer in Australia? Yes No

Do you agree to undergo a National Criminal History Record Check as required by the Australian Government in order to volunteer for the CVS program? Yes No

If you lived in a country other than Australia as a citizen or permanent resident since turning the age of sixteen, are you willing to sign a Statutory Declaration stating that you have never been convicted of an offence that would preclude you from being a CVS volunteer? Yes No

Additional Question

Where did you hear about CVS?:

Go Volunteer
CVS Website
Print Media
Expo
Word of Mouth
Auspice Referral
Agency Referral
Other - please specify

Please be aware that you will be required to provide the names of two referees as part of your reference check before your commencement as a Community Visitor.