E-Volunteer Registration

Volunteer Registration Form

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Personal Particulars

First Name

Last Name

NRIC

Date Of BIrth

Country Of Birth

Gender

Age

Highest Qualification

Race

Marital Status

Religion

Name Of Church

If you selected Christian for Religion, please state name of Church.

Home Address 1

Home Address 2

Postal Code

Citizenship

Tel (M)

Occupation

Do you drive?

Yes

Do you have a car?

Yes

Spoken Language

Volunteer Information

I am able to volunteer in:

I can volunteer my service for:

At least 1 year

At least 6 months from:

References (To be completed) other than family members

Name	Relationship	Contact No.	Email	Occupation	Years Known

Current or last known Employment

From (Mth/Yr)	To (Mth/Yr)	Name of Organisation	Position Held

Questionnaire

Do you have prior experience in dealing with children?

Yes

Are you open to attend training programmes for volunteers?

Yes

Do you have any medical condition?

Yes

I confirm that the above information is true to the best of my knowledge and agree to abide by the terms and conditions as stipulated by Chen Su Lan Methodist Children's Home. I shall not be participating in the discussion and decision making of any matters that I have an interest in. I agree that if I become aware of any information that might indicate that this disclosure is inaccurate or that I have not complied with the conflict of interest policy, I will notify the Volunteer Manager of CSLMCH immediately.

Stipulation of Consent (Personal Data Protection Act 2 012)

In compliance with the Personal Data Protection Act (2012) we kindly seek your consent to collect, use and/ or disclose your personal data in relation to your application to volunteer at the Chen Su Lan Methodist Children's Home (CSLMCH).

Chen Su Lan Methodist Children's Home will only collect, use and/ or disclose your personal data for the purposes of administration, screening by Ministry of Social and Family Development, public relations, and to contact you regarding your volunteering services and/ or other activities, events and programmes organised by CSLMCH.

Please share with us how you know about our Home?

Conflict of Interest Disclosure Statement

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With regard to my service as a volunteer, I have the following potential conflict of interest to report:
Check or elaborate as appropriate.

I am affiliated* with Chen Su Lan Methodist Children’s Home, either as a former staff member or as a previous beneficiary who received services from the Home.
Please specify your affiliation:

I am affiliated* to

Name of CSLMCH.

Designation of CSLMCH.

Others:

* Affiliation refers to being connected to the organisation, including having served previously as staff or a beneficiary, or being connected to another party within the organisation, such as a spouse, child, parent, sibling, or close associate; any corporation, business or non-profit organisation of which you serve as staff, officer, board member, partner, participate in management or are employed by; any trust or other estate in which you have a substantial interest or as to which you serve as a trustee or in a similar capacity. Please note that this is not an exhaustive list of possible affiliations, and if you are unsure, we encourage you to consult the Volunteer Manager of CSLMCH for clarification. When in doubt, it is always better to declare.

Please elaborate on the potential conflict arising from the above situation with regards to the transaction concerned (e.g. nature of service/ transaction, if affiliated person involved, the identity of the affiliated person and your relationship with that person)

With regards to my service as a volunteer in CSLMCH, I do not have any potential conflict of interest with any corporate organisation/ individual.

I shall not be participating in the discussion and decision making of any matters that I have an interest in. I agree that if I become aware of any information that might indicate that this disclosure is inaccurate or that I have not complied with the conflict of interest policy, I will notify the Volunteer Manager of CSLMCH immediately.

Undertaking to Safeguard Confidentiality of Personal Data

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My attention has been drawn to:
a. the Personal Data Protection Act 2012;

b. the Computer Misuse Act 1993;

c. the Official Secrets Act 1935 and in particular to Section 5 thereof which relates to safeguarding of official information;

d. the Income Tax Act 1947 and in particular to sections 6(1), (2) and (3), which relates to official secrecy of personal data related to income;

e. the Children and Young Persons Act 1993;

f. the Vulnerable Adults Act 2018; and

g. the Women's Charter 1961.
I understand that in the course of my work, and/or consultancy with any government department, statutory board or government-owned company as a volunteer at Chen Su Lan Methodist Children's Home, I may acquire, receive, or gain access to confidential information, which includes but is not limited to personal data, which is subject to the protection of confidentiality under the Personal Data Protection Act 2012, the Computer Misuse Act 1993, and the Income Tax Act 1947. I also acknowledge that all of the confidential information is, or is deemed by the Government to be, secret official information that is covered by the Official Secrets Act 1935.
I undertake to be bound by the obligations as to protect the confidentiality and secrecy of confidential information, including personal data, that I may acquire, receive or gain access to; and in particular,
a. To regard and to deal with all confidential information as secret and confidential;

b. Not to access, monitor, use or process the confidential information or any part thereof except where it is reasonably necessary for the performance of my official duties;

c. Not to disclose to any person any confidential information without prior written consent of MSF, other than to another person who has provided a similar written undertaking to the Government or permitted by the Government to receive the confidential information and only for the performance of my official duties;

d. Not to publish or broadcast to the public any confidential information without prior written consent from MSF;

e. Not to process, store, access or transfer any confidential information outside Singapore, or allow parties outside Singapore to have access to it, unless with the written consent of MSF and subject to such conditions as MSF may impose;

f. To take all reasonable measures to ensure that the confidential information is protected against loss or damage (whether accidental or otherwise), and against unauthorised access, use, modification, disclosure or other misuse, and that only authorised personnel have access to the data;

g. To return to MSF any and all confidential information, and shall ensure that no part or copies thereof (including electronic records) are retained in my possession, whenever required by MSF or upon the expiration or termination of my employment with my employer or where such confidential information is no longer necessary for the performance of my official duties; and

h. Not to produce in any court any income information, or to divulge or communicate to any court any income information coming under my notice in the performance of my official duties except as may be necessary for the purpose of carrying into effect the provisions of the Income Tax Act 1947, or in order to institute a prosecution, or in the course of a prosecution, for any offence committed in relation to income tax.
I further understand and agree that any breach or neglect of this undertaking may render me liable to prosecution under the relevant legislation, including but not limited to the Personal Data Protection Act 2012, the Computer Misuse Act 1993, the Official Secrets Act 1935, the Income Tax Act 1947, the Children and Young Persons Act 1993, the Vulnerable Adults Act 2018, and the Women's Charter 1961.

Full name in BLOCKS

Designation

Name & address of Company

Date

NRIC/Passport No.