Volunteer registration

General Information

  • Please personally complete this application form in full.
  • If successful, this information will be retained by NZBS. You are entitled to access all personal information upon request.
  • All information is requested in accordance with the Privacy Act 1993, and the Human Rights Act 1993.

* Indicates a required field

Applicant to complete

Contact during working hours OK?
Are you a blood donor?
Have you done volunteer work before?
Where would you like to undertake your volunteer duties?

Health

Do you have any condition/s that may affect how you undertake the duties?
Do you have any injury or medical condition caused by gradual process, disease or infection which the job may aggravate e.g. sensitivity to chemicals or repetitive strain injuries?
If yes, please provide details.
Do you have a pacemaker?
Some equipment within our laboratory and donor floor will affect pacemakers.
Is there any reason which would bring into question the desirability of your appointment as a Volunteer with NZBS, such as any criminal offences which you have been charged with and pending trial or have been convicted or dismissal from any employment?

Referees

Referee one

Referee two

Next of kin

Declaration

I declare that the information I have supplied in this application is true and correct to the best of my knowledge. If I am accepted as a Volunteer and the foregoing information is incorrect it may result in the termination of my responsibilities as a Volunteer. I consent to New Zealand Blood Service seeking confidential verbal or written information about me from my nominated referees, relating to my application to become a volunteer and authorise the information sought to be released. If successful, this information will be retained by NZBS in a secure place. You are entitled to access all personal information upon request. All information is requested in accordance with the Privacy Act 1993, and the Human Rights Act 1993.

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