D64 Core Staff Application - Carey Park, Akl
Dates: Tuesday (evening) 16th April to Sunday (11am) 28th April 2019
Name
*
First Name
Last Name
Preferred name
*
Like to be known as
Mobile Number
*
-
Email
*
example@example.com
Preference of Core Staff Role for D64
*
Gender
*
Male
Female
Other
T-Shirt Size (Note: Unisex sizing)
XS
Small
Med
Large
XL
XXL
Dietary Requirements
None
Vegetarian
Gluten Free
Dairy Free
Food Allergy (Please specify)
Other (Please specify)
Dietary Requirement details
Birth Date
*
/
Day
/
Month
Year
day/month/year
Physical Address
*
Please include Post code
Phone Number - Land line
-
Area Code
Phone Number
Previous Core Staff Experience (Please specify)
Previous DFK or DFT team leader experience (Please specify)
What motivates you to be on the CS team?
What unique things would you bring to the Discovery Programme?
What role would you like to perform at Discovery in the Future?
Do you have any medical conditions that may affect your ability to do your CS role?
*
Do you have any mental health concerns that may affect your ability to do your CS role?
*
Do you currently have any other health challenges that we should be made aware of? (Please include any current drug or alcohol addictions)
*
Please list any tertiary qualifications
Please list any other relevant training or qualifications
Please provide details of any work experience in youth oriented roles
Please provide details of other work experience
Is there anything else we should know about you?
Social Media details (for end of programme contact list)
Emergency Contact Information
Emergency contact Name
First Name
Last Name
Emergency contact Phone Number
-
Area Code
Phone Number
Emergency contact Email
example@example.com
Verbal Referee Information
Please provide contact details for two referees. Please note that one must be from outside of Discovery
Referee One Name
First Name
Last Name
Referee One Contact Number
-
Area Code
Phone Number
Referee Two Name
First Name
Last Name
Referee Two Contact Number
-
Area Code
Phone Number
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