Employee/Volunteer Registration

First Name *

Surname *

Email address

Residential Address - Street

Residential Address - Suburb

Residential Address - Post Code

Postal Address (if not same as residential)

Phone number - home

Phone number - mobile

Emergency contact (name and number)

Date of birth

Blue Card Number

Blue Card Expiry Date

First Aid Qualifications (include dates)

Internet social media links (Website, Facebook, LinkedIn, etc.)

Other Qualifications

Other Relevant Experience

Under what arrangement have you agreed to work at Trevena Glen

What areas are you available to help with

Specify your general availability

Immunisations and Health Issues

The following immunizations are recommended:

  1. Q Fever
  2. Tetanus
  3. Influenza (annual)
  4. Rabies
  5. Hepatitus B
  6. Measles
  7. Mumps
  8. Rubella
  9. Whooping Cough
  10. Chicken Pox

Please specify here if you have any known health issues which could impact your work on the farm. Since there is a physical aspect to the work that includes lifting and carrying of items, along with responsibility for health and safety of visitors, it is important that we are aware of any potential issues. Some examples would be epilepsy, chronic heart conditions, severe allergic reactions, etc. We would also like to be aware of any chronic issues which could affect attendance reliability - we generally plan work rosters up to a term in advance and would like to minimise last minutes changes or at least have contingency planning in place to accommodate the possibility.

Bank Name


BSB Number

Account Number

Account Name