Volunteer application form

Identification:

*First name:       Middle initial:      *Last name:  

*Are you currently 19 years old or older?     Yes:     No:

Driver's licence number:

Address and contact information:

*Street number:       *Street Name:      Apt. : 

City:       Postal Code:      

*Home phone:     Cell phone:

E-mail:

Employment information:

Are you currently employed?     Yes:     No:

May we call you at work?     Yes:     No:

Work phone:

Skills and experience:

Please list any languages you speak in addition to English (if applicable):

*How did you hear about us?:

Have you done volunteer work before?:     Yes:     No:

If yes, please list the organization(s) and describe your role:

*Explain what you feel you can bring or add to our team:

Requirements:

*Are you able to complete a minimum of two (2) five-hour shifts per month?
    Yes:     No:

*Are you willing to make a one-year committment to the program?
    Yes:     No:

*Are you able to complete the required training? (10 three-hour lectures)
    Yes:     No:

*Have you ever been charged and/or convicted of a criminal offence for which a pardon has not been granted?*
    Yes:     No:

References:

Please provide one personal and one professional, education or volunteer reference.

Reference 1:

*Name:     *Phone number:     *Relationship:

Reference 2:

*Name:     *Phone number:     *Relationship:

*I certify that all the information provided above is truthful and accurate     Yes: