Volunteer Application

Program of Interest

Preferred Work Location

Eden Place Drop-In Centre
Resource Centre
Finance & Operations
Partnership Place
Court Support Services
Youth Net

Brampton
Mississauga
Caledon (limited opportunities)
      (N.B. Sometimes the preferred location,
      program and days desired will not be
      available.)

Type of Work

Please check which volunteer job(s) you would like to pursue within our organization:

Clerical
Special Events
Fund Raising
Newsletter writer/Media relations
Self-help Facilitator
Displays/Health Fairs
Board of Directors

Other (please specify)

Library
Speaker
Youth Activities
Information and Referral
Interpreter
Client/Social Activities

Personal Information

Name:
Home Address:
City:
Postal Code:
Home Phone:
Business Phone:
E-mail Address:
Present Occupation:
Present Employer:
Languages:

Are you a licensed driver? Yes No Class:

Access to a car? Yes No

Do you live and/or work in Peel Region? Live Work

Do you have any health considerations you fell may place a limit on the type of Volunteer Work you do? Yes No If you do, please describe:


If required would you consent to a criminal record check? Yes No

Emergency Contact

Name:
Address:
Phone number:
Relationship:

Previous Volunteer Experience

Organization:
Type of Work:
Organization:
Type of Work:

Please include special skills, interests, hobbies, etc. which you feel may be useful to you as a volunteer with us:


Please include any additional information:


What do you hope to accomplish through volunteer work?

References

Please provide us with two personal references:

Name:
Address:
Phone number:
Relationship:

Name:
Address:
Phone number:
Relationship:

First Aid/CPR Training

Do you have First Aid training? Yes No	Do you have CPR training? Yes No

Is the training current? Yes No	Is the training current? Yes No

Interested in re-certification (if offered)? Yes No	Interested in re-certification (if offered)? Yes No

Availability

Please indicate the days and times that would be most suitable to volunteer:

	Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
Morning
Afternoon
Evening
N/A

For what period of time are you available?
6 months 1 yr. 2 yr. Other:

I, the undersigned, do certify that the information provided in this application is accurate and complete according to the best of my knowledge and I consent to disclosure of required information by employer(s), references, etc., stated herein. Furthermore, should I be accepted as a volunteer, it is my understanding that I will be provided with training, support and supervision.

Additional comments:

Please enter the letters as seen above before submitting: