Register to be a Volunteer

Thank you for your interest in becoming a volunteer. Please fill out this form in full and someone from our friendly team will be in touch. 

The information collected will be used and held by New Zealand Blood Service. For more information about how we collect, use and store your information, please refer to our Privacy Statement, which can be viewed at www.nzblood.co.nz. You have a right to access and request the correction of the information in accordance with the Health Information Privacy Code and related New Zealand law.  We take privacy breaches seriously and do everything we can to prevent them from occurring. In the event a privacy breach does occur, we will comply with the notification requirements in the Privacy Act 2020. If you have received information in error or are concerned you may have been the subject of a privacy breach, please contact the New Zealand Blood Service Privacy Officer at privacy@nzblood.co.nz.

Fields marked with an asterisk are mandatory.

 

Applicant to complete

*Contact during working hours OK?
*Are you a blood donor?
Have you done volunteer work before?*
Where would you like to undertake your volunteer duties?

Health

Do you have any injury or medical condition caused by gradual process, disease or infection which the job may aggravate e.g. sensitivity to chemicals or repetitive strain injuries?
If yes, please provide details.
Do you have a pacemaker?
Some equipment within our laboratory and donor floor will affect pacemakers.
Is there any reason which would bring into question the desirability of your appointment as a Volunteer with NZBS, such as any criminal offences which you have been charged with and pending trial or have been convicted or dismissal from any employment?

Referees

Referee one

Referee two

Next of kin

Declaration

I declare that the information I have supplied in this application is true and correct to the best of my knowledge. If I am accepted as a Volunteer and the foregoing information is incorrect it may result in the termination of my responsibilities as a Volunteer. I consent to New Zealand Blood Service seeking confidential verbal or written information about me from my nominated referees, relating to my application to become a volunteer and authorise the information sought to be released. If successful, this information will be retained by NZBS in a secure place. You are entitled to access all personal information upon request. All information is requested in accordance with the Privacy Act 1993, and the Human Rights Act 1993.