Staff Induction Form Please fill in some details about you for us below. Please Note:if you are unable to tick the boxes, please click on the statements beside the box and the box should fill. Personal InformationName First Last Date of Birth: DD slash MM slash YYYY Email* Phone Number(s)*Please provide us with your contact phone number(s) Address* Street Address Address Line 2 Town / City State Post Code Child Protection Number* This may also be known as your Working With Children Check Number. If you do not have one, please write your application number here.Child Protection Expiry DD slash MM slash YYYY State of Issue of Child Protection Number Emergency Contact Please provide us with the name & number of an emergency contact person for you.Young Life Australia InformationPlease indicate the role you are applying for*Choose Role:InternStudent StaffField StaffArea ManagerRegional ManagerLocal Area AdministrationNational OfficeYoung Life Area* Do you regularly attend church?* Yes No Name of your local church / faith community AcknowledgementStaff Statement*I authorize, at Young Life Australia's discretion, investigation of all statements made by me in this application, and review of any civil or criminal records, which may exist, concerning me, except for such records as are sealed according to State or Commonwealth law. I further authorize Young Life Australia, at its discretion, to contact employers, references and others whose names are provided on this application form, or whose names may be identified by me in an interview, and I authorize such persons to provide Young Life Australia with information requested by Young Life Australia regarding me. I further release any such individuals, as well as Young Life Australia, from any claims I might have arising out of any discussions involving me, or the provision of any information or records regarding me. In the event I become an employee of Young Life Australia, I understand that false or misleading information given in my application or interviews may result in dismissal. I agree Please ensure that you hit the SUBMIT button so that your information is captured. If you do not hit submit, you will be asked to come & re-complete the form. You must complete this form in order to move to the next topic.