Road Ready Mentoring Program Application

Road Ready Driving Mentor Application

Minimum Requirements

Prior to completing this application form, the applicant (volunteer mentor) must meet the minimum requirements to join the Road Ready Mentoring Initiative as listed below:

Valid open Australian Driver’s Licence (held for a minimum of one year) *

Yes

Eligible to work with young people aged 16-24 *

Yes

All volunteer mentor drivers must be 25 years of age or older. Please note: This is a mandatory condition for participation in the Road Ready initiative.

If the applicant meets these minimum requirements, then all sections of the following form must be completed in full prior to submitting this application for review.

Your information

First name *

Surname *

Date of Birth *

Email *

Mobile Phone Number *

Address *

Suburb *

State *

Post Code *

Gender *

Identifies as *

Blue Card & Drivers Licence Information

Blue Card Number

I need help with a Blue Card.

Date of Issue

Expiry Date

Driver’s Licence Number

Date of Issue

Expiry Date

What type of vehicle are you licenced for?

Do you have any medical conditions?

If yes, provide details

Any special needs or requirements?

If yes, provide details

In the past three years:

Has any insurer declined or cancelled a policy, imposed specific conditions on a policy, or refused a claim?

If yes, please provide more details

Have you claimed for loss or damage relating to car insurance?

If yes, please provide more details

Have you committed any criminal act relating to fraud, theft, burglary, drugs, arson, or malicious or wilful damage?

If yes, please provide more details

Has your driver’s licence been suspended, cancelled, disqualified, or restricted?

If yes, please provide more details

Skills and Previous Experience

Your previous skills and experience, a part from driving, can assist us in being able to potentially achieve other outcomes that help our initiative empower youth.

Please list industries in which you have previously worked *

Please list any skills you may have *

Declaration

I declare that the information provided above is true and correct to the best of my knowledge and I agree that I may be contacted by 5FOLD regarding the Road Ready initiative. I also understand that this information will be held by 5FOLD in accordance with the Privacy Act 1988 (Cth).

HP:

Road Ready Mentoring Program Application

Road Ready Driving Mentor Application

Minimum Requirements

Your information

Blue Card & Drivers Licence Information

Skills and Previous Experience

Declaration

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