CONTACT DETAILS

NAME
SURNAME
GENDER FEMALEMALE
DATE OF BIRTH
NATIONALITY
PASSPORT / ID NUMBER
PRESENT ADDRESS
ADDRESS
TOWN / CITY
POSTAL CODE
COUNTRY —Please choose an option—AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamas, TheBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurmaBurundiCambodiaCameroonCanadaCabo VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCote d'IvoireCroatiaCubaCuracaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth KoreaNorwayOmanPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVenezuelaVietnamYemenZambiaZimbabwe
PHONE/CELL NUMBER
EMAIL ADDRESS

PERSONAL PROFILE

WHY WOULD YOU BE A GOOD VOLUNTEER MATCH FOR PEBBLES PROJECT?

PLEASE PROVIDE BACKGROUND INFORMATION ABOUT YOUR PREVIOUS WORK EXPERIENCE / STUDIES

HAVE YOU WORKED AS A VOLUNTEER BEFORE? PLEASE ELABORATE:

DO YOU POSESS ANY OF THE FOLLOWING SKILLS? TEACHING/ LITERACY AND MATHEMATIC TUTORINGCARPENTRYDANCE/DRAMA/MUSIC/SPORT COACHINGARTS AND CRAFTSFUNDRAISING & OTHER RELATED SKILLSGRAPHIC DESIGN/ VIDEOGRAPHY /PROFESSIONAL PHOTOGRAPHYWORKSHOP FACILITATION

IF YES, PLEASE ELABORATE:

DO YOU HAVE ANY OTHER SKILLS / EXPERIENCE THAT MAY BE USEFUL? PLEASE ELABORATE

WHICH AGE GROUPS ARE YOU MORE COMFORTABLE TO WORK WITH? 0 – 6 YEARS7 – 18 YEARS18+ALL AGE GROUPS

AVAILABILITY

NUMBER OF DAYS PER WEEK
TIME OF THE DAY
WHICH DAYS OF THE WEEK
IF ON WEEKENDS OR WHEN AVAILABLE, PLEASE EXPLAIN
PLEASE SPECIFY YOUR PREFERRED START DATE:
PLEASE SPECIFY YOUR PREFFERED END DATE:

REFERENCES
PLEASE NOTE – REFEREES SHOULD PREFFERABLY NOT BE RELATIVES AND SHOULD BE ABLE TO REFLECT ON YOUR WORK ETHIC FOR A MINIMUM OF 1 YEAR.

REFEREE 1:
NAME
ADDRESS
TELEPHONE NUMBER
EMAIL
RELATIONSHIP TO YOU

REFEREE 2:
NAME
ADDRESS
TELEPHONE NUMBER
EMAIL
RELATIONSHIP TO YOU

DO YOU HAVE ANY CRIMINAL CONVICTIONS YOU NEED TO DISCLOSE? YESNO
IF YES, EXPLAIN

PLEASE RATE YOUR FLUENCY IN ENGLISH: POORBASICGOODEXCELLENT

PLEASE RATE YOUR ENGLISH WRITING SKILLS: POORBASICGOODEXCELLENT

PLEASE RATE YOUR FLUENCY IN AFRIKAANS: POORBASICGOODEXCELLENT

PLEASE RATE YOUR AFRIKAANS WRITING SKILLS: POORBASICGOODEXCELLENT