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Leadership Application

Online Application

* = required field

Note: It may be easier to type your answers in a Word processor and paste it into the form.

Step 1: Personal Details:

First Name:*

Surname:*

Date of Birth:*

Sex:*

Address - Apartment/Unit:

Address - Number & Street:*

Address - Suburb:*

Address - State:*

Address - Postcode:*

Phone - Home:

Phone - Mobile:

Email:

Marital Status:*

Step 2: Risk Management:

Have you any physical handicaps or conditions preventing you from performing certain types of activities relating to children’s or youth work?*

If Yes, please explain

Have you ever been involved in, accused of or convicted of child abuse or a crime involving actual or attempted sexual molestation of a minor?*

If yes, please contact the PYV Leadership Accreditation Team.

Do you have a current "Working With Children Check"*

If yes, please supply WWC Check number:

If you are 18 years or older, and do not have a current "Working With Children Check" you must apply for one. For more information visit www.justice.vic.gov.au/workingwithchildren.

Step 3: Church Involvement:

Name of church of which you are a member:

Name of Minister:

How long have you been a member?

Please list names and suburb of any other churches you have attended regularly during the past five years:

Please detail your historical and current involvement at your church (focusing on youth work):

Please list any gifts, callings, training, education or any other factors that have prepared you for youth work:

Please detail how you became a Christian and your subsequent spiritual growth, (minimum 150 words):

Step 4: Past PYV Involvement:

Please detail your involvement in PYV up to now (i.e. events & camps attended, any involvement in or helping out in other areas, etc.)

Step 5: Future PYV Involvement:

Please indicate areas you would like to be involved in, either for events or camps:

Music – instrument(s):

First Aid – qualifications / training:

Cooking / Kitchen Hand – qualifications / training:

Swimming Supervisor – qualifications:

Other: (see PYV website for more job descriptions and leadership positions)

Step 6: Personal References:

One reference must be either your minister or in the case of a vacant parish, your session clerk. Please have church references, not employers or relatives. NB If you are related to the minister, please use the session clerk/elder as a referee.

Number 1

Relationship:*

Name:

Postal Address:

Postcode:

Telephone(s):

Email:

How does your reference prefer to be contacted?Phone / Email / Visited

Number 2

Relationship:

Name:

Postal Address:

Postcode:

Telephone(s):

Email:

How does your reference prefer to be contacted?

Step 7: Applicant's Statement

The information contained in this application is correct to the best of my knowledge. I authorise any references or churches listed in this application to give you any information they may have regarding my character and fitness for youth work. I release all such references from liability for any damage that may result from furnishing such evaluations to you, and I waive any right that I may have to inspect references provided on my behalf. Should my application be accepted, I agree to be bound by the PCV’s ‘Breaking the Silence Policy’, my signed leader’s Declaration of Commitment, PYV’s Constitution, policies and Council decisions, and to refrain from unscriptural conduct in the performance of my services on behalf of PYV.

Today's date: