Date of Birth
Step 2 of 6
Highest level of education
Are you still studying? YesNo
If yes, what course of studies are you pursuing?
Give a brief resume of your work experience and skill
Are you working at present? YesNo
Do you have any other expertise you would like to share with us?
Step 3 of 6
Marital / Relationship Status
Do you have dependants? YesNo
If yes, what is your responsibility to them?
What are your hobbies/leisure activities
Do you have a valid driver’s licence? YesNo
Do you have your own transport? YesNo
Have you ever been involved with the police/courts? YesNo
If yes, please provide the reason?
Step 4 of 6
Have you been involved in volunteer work before?
If yes, what kind of volunteer work did you engage in?
How could you most like to assist Child Welfare Durban & District
Do you consider this to be a long term relationship? YesNo
How often would you be able to help?
What times are you available during Weekdays?
What times are you available during Weekends?
Step 5 of 6
Please furnish the names of two referees, other than family, who have known at least three years.
Name & Surname
Step 6 of 6
Thank you for taking time to complete this questionnaire.
References will only be taken from the names furnished. All information given will be treated in the strictest confidence.
I hereby confirm that all information submitted is correct and true. Yes