Name

Gender
Male
Female

Date of birth

Email
Address
Contact phone
Alternative phone

NEXT OF KIN:
Name of Next of Kin

Relationship to you

Address of Next of Kin

Telephone of Next of Kin

PLEASE TELL US MORE ABOUT YOURSELF
(All information will be treated confidentially)

Please give details of any physical or mental illness you may have. Is there any medication you may require?
Medical Condition

Are you are happy to abide by the Centre rules, which include not smoking or drinking alcohol on the premises?
I am happy to abide by KMCA rules

Have you attended an NKT Buddhist Centre before?
Yes
No

If so which one? Please give details
other_centre

Is there a person you would like to name as a referee?

Have you been on a working visit at KMC Australia before?
Yes
No

Why would you like to do a working visit at KMC Australia?
whyKMCA

How did you hear about us?
howHear

Do you have skills or experience in these areas? (gardening, painting & building, plumbing, housekeeping)?

Select which operating systems are you familiar with:
gardening
painting
building
plumbing
housekeeping
cooking

Please list any other skills you may have
otherSkills

When would you like to do your working visit?
when