Staff Information Form 2022

2022 Immersion Staff Personal Information

Form to be completed by all staff participating in an immersion.

Step 1 of 5

Personal Information
First Name*
Last Name*
Preferred Name*
Gender*
Date of Birth*

Day
Month
Year
How many immersion programs have you lead for Red Earth?*
Profile Photo
Something professional and fun!
Accepted file types: jpg, png, jpeg, Max. file size: 2 MB.
Mobile Phone*
Mobile Phone on immersion program same as above?*
Note: Immersion staff must be contactable via the Telstra network on a Red Earth program.
Email*
Preferred Method of Contact
What class of driver licence do you hold?*
Driver licence
Please upload an image of the front and back of your licence, in one document.
Accepted file types: pdf, Max. file size: 8 MB.
Residential Address*
Street Address City State Post Code Country
Postal Address same as above?*
Postal Address
Street Address City State Post Code Country
Nearest regional or capital city?*
City
Shirt Size*

First Aid Qualifications
Applies to all regions. Immersion Leaders are required to hold a current Remote First Aid certificate, including Provide CPR.
Do you have a Remote First Aid certificate, or higher?*
Remote First Aid certificates expire after 3 years.
Remote First Aid expiry date*

Day
Month
Year
Remote First Aid certificate
Accepted file types: pdf, Max. file size: 5 MB.
Do you have a Senior First Aid certificate?*
Senior First Aid certificates expire after 3 years.
Senior First Aid expiry date*

Day
Month
Year
Senior First Aid certificate
Accepted file types: pdf, Max. file size: 8 MB.
Do you have a Provide CPR certificate?*
Provide CPR certificates expire after 1 year.
Provide CPR expiry date*

Day
Month
Year
Provide CPR certificate
Accepted file types: pdf, Max. file size: 8 MB.
Water Rescue Training
Applies to all regions.
Do you have a basic water rescue qualification, or higher?*
E.g. Pool Bronze Medallion, Pool Lifeguard
Water rescue expiry date*
E.g. Pool Bronze Medallions expire after 1 year.

Day
Month
Year
Water rescue certificate
Accepted file types: pdf, Max. file size: 8 MB.
4WD Training
Applies to all regions. Immersion Leaders are required to have an approved 4WD certification in order to transport Red Earth participants.
Do you have a 4WD training certificate?*
E.g. RIIVEH305F Operate and maintain a 4WD vehicle
4WD training certificate
Accepted file types: pdf, Max. file size: 8 MB.
Please describe your equivalent 4WD training.*
E.g. Unit of study codes, training courses

2022 Immersion Staff Personal Information

Step 1 of 5

Personal Information

Financial Information

Medical Information

First Aid Qualifications

Water Rescue Training

4WD Training

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