Name: Mr Mrs Ms Miss Dr
Given names :
Surname:

Postal address:


..Postcode:

Telephone B/H:
Telephone A/H:

Date of birth:

Highest level of education completed: High School College Diploma Degree Please Select

Please list three previous employers and tasks you were responsible for (If applicable):

Employer 1:

Tasks:

Employer 2:

Tasks:

Employer 3:

Tasks:

What areas of the Museum are you interested in:

List your most favourable attributes (e.g. Personnel, Joinery):

Do you have any health problems which may limit your ability to work in certain jobs in the Museum?
Yes No

If Yes, please give details:

Are you a member of the Friends of the Museum?
Yes No

I consent to a Criminal Record check:
Yes No

Other comments (Please use this area for any other information you feel would assist in processing your application):

If successful in my application to volunteer at the Museum I understand that all voluntary workers at the Queen Victoria Museum and Art Gallery receive no remuneration and that the Museum is under no obligation to employ me as a result of my voluntary contribution.

Signature: ______________________________________ Date:

Please fill out all details and return to:
Lauren Dean
Volunteer Administrator
Queen Victoria Museum and Art Gallery
PO Box 403
Launceston TAS 7250

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