/ Volunteer Services
Application Form

Do you want to improve the quality of life of one of our patients or users? Thank you! We invite you to fill in this form, save it and then e-mail it to the institution of your choice (the addresses are listed on our website).

Because our volunteers may be in contact with our vulnerable patients:

1)All applicants must have a criminal background check;

2)All of your references will be verified;

3)All applicants must be interviewed before a decision can be reached.

INFORMATION
FAMILY NAME / Click here to type your text / FIRST NAME / Click here to type your text
MAIDEN NAME (if different) / Click here to type your text / TELEPHONE / Click here to type your text
E-MAIL / Click here to type your text / CITY / Click here to type your text
ADDRESS / Click here to type your text / POSTAL CODE / Click here to type your text
PROVINCE / Click here to type your text / ARE YOU A STUDENT / Yes No
DATE OF BIRTH / Click here to type your text
LANGUAGES / French English Other(s) / SPECIFY / Click here to type your text
REFERENCES – Please supply the names of two (2) references, other than family members
FAMILY NAME / Click here to type your text / FIRST NAME / Click here to type your text
E-MAIL / Click here to type your text / TELEPHONE / Click here to type your text
RELATIONSHIP / Click here to type your text
FAMILY NAME / Click here to type your text / FIRST NAME / Click here to type your text
E-MAIL / Click here to type your text / TELEPHONE / Click here to type your text
RELATIONSHIP / Click here to type your text
IN CASE OF EMERGENCY – Who should be contacted?
FAMILY NAME / Click here to type your text / TELEPHONE - day / Click here to type your text
FIRST NAME / Click here to type your text / TELEPHONE - evening / Click here to type your text
E-MAIL / Click here to type your text / CELL PHONE / Click here to type your text
RELATIONSHIP / Click here to type your text
YOUR AVAILABILITY? / SHORT TERM ASSIGNMENT
Monday / Tuesday / Wednesday / Thursday / Friday / Saturday / Sunday
Morning
Afternoon
Evening
NOTES / Click here to type your text
TELL US ABOUT YOURSELF!
Why do you want to volunteer?
Cliquez ici pour taper du texte.
What type of assignment do you want?
Accompaniment / Clerical Work / Recreation / Friendly visits
Fundraising / Tutoring / Gardening / Support
Driver / Animation / Welcoming / Sales
Do you have any particular talents (yoga, dance, music, etc.)?
Yes No / If yes, please explain: Click here to type your text
Are there any restrictions which could affect your capacity to do your job?
Yes No / If yes, please explain: Click here to type your text
Do you have experience as a volunteer?
Yes No / If yes, please describe your role and the name of the organization.
Click here to type your text
Describe your work experience?
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What are your interests?
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What is the best time to reach you?
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