Volunteer Application Form

Thank you for your interest in volunteering with our organization. Please be advised, by clicking "submit", you are giving us permission to contact your references and certify that all information is correct and realize that falsified information could lead to your termination with this agency. You also agree to allow Community Support Connections to keep both personal and health information required for you to provide service. You also agree to allow CSC to send you a monthly volunteer e-newsletter, which you can unsubscribe from at any time.

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Date: *

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Title:

Mr.

Mrs.

Miss

Ms.

     

First Name: *

     

Last Name: *

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Address:

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City:

     

Postal Code:

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Email:

     

Home Phone: *

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Birthdate (optional):

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Age Category:

under 18

18-25

26-39

40-59

60+

     

Occupation (optional):

     

Current place of employment (optional):

(If retired, previous place of employment/description of work)

     

Work Phone:

     

Cell Phone:

     

Emergency Contact: *

     

Emergency Contact's Phone Number: *

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Relationship of Emergency Contact: *

     

How did you hear about our organization?:

     

List any languages in which you are fluent:

     

Areas of Interest (please select all that apply): *

Friendly Visitor

Meals on Wheels Driver /Runner

Driver Escort

Office Volunteer

Meals on Wheels Order packer/Carrier Cleaner/Porter/Labeler

Telephone Support Volunteer

List Shopper

Community Dining Host /Hostess

Bingo Volunteer

Board of Directors

Shopper Escort

Community Dining Driver

Fundraising / Event Volunteer

Seniors Fitness Instructor (WALC Program)

Volunteer Fairs

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Availability: *

Please indicate on what days and times you are available. For example: Tuesday afternoon, Wednesday evening, etc)

     

I am available to begin: *

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How often each week?:

     

Please explain any health issues that might affect your ability to volunteer:

(allergies, injuries, and conditions)

     

Reference #1 (Personal): *

(Neighbour, Friend)

     

Reference #1 - Phone Number: *

Please enter the contact number of your personal reference here.

     

Reference #1 - Email:

Please give the email address of your personal reference here.

     

Reference #2 (Professional): *

(Boss, Co-worker, Teacher)

     

Reference #2 - Phone Number: *

Please add the contact number of your professional reference here.

     

Reference #2 - Email:

Please give the email address of your professional reference here.

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Hobbies/Interests:

(Cooking, Crafting, Dance, Fitness, Gardening, Graphic Design, Hiking, Knitting/Sewing, Photography, Painting, Reading, etc.)