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VOLUNTEER APPLICATION

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Prefix
First Name
MI
Last Name
Home Address
City
Province
Postal Code
Primary Telephone No.
Primary Language Spoken
Emergency Contact Information
First Name
Relationship
Home Address
Postal Code
City
Province
Primary Telephone No.
Secondary Telephone No.(Optional)
About YouPlease provide as much information as possible so that we can match you with the right volunteer opportunity Age range
Highest Level of EducationPick the option that best describes you
If you selected other, please describe: High school students specify grade/Postsecondary students specify program of study
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Select your top three reasons for volunteering
If you selected other, please specify:
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Do you have a valid First Aid & CPR certificate?
Type of Certification:
Expiry Date:
Do you need volunteer hours to fulfill academic requirements?
If yes, how many?
When are these hours due?
What types of volunteer roles are you interested in?
Skills ProfileIn 250 words or less please provide details on any or all of the following: Your current or past work, volunteering, education or training, relevant skills and talents you would like to share:
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Have you ever been convicted of a criminal offence for which you have not received a pardon?

Please Note: Volunteer placement offers are conditional upon providing an acceptable Police Vulnerable Sector Records Search.


Important Notice Privacy Statement: Personal information is collected under the statutory authority of the Occupational Health and Safety Act. Personal information on this form will be used to determine suitability for volunteer initial and on-going placements, as well as program evaluation and assessment. Questions about the collection and use of personal information should be forwarded to maltonblack@maltonbda.com.

Declaration


Please read carefully before checking off the box below:


By checking this box I hereby certify that all of the information that I have provided in this application is accurate and true and I understand that any false or misleading statements or deliberate omissions made by me on this application or during the volunteer recruitment and selection process may be sufficient cause for the cancellation of this application and, if I have been placed in a volunteer position, for the immediate termination of my volunteer placement.

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