SSAIC CRISIS LINE

Volunteer Application

Saskatoon Sexual Assault & Information Centre

201 - 506 - 25th Street East

Saskatoon, SK S7K 4A7

306-244-2294

Email:

Please Print

Full Name: ______

First Middle Last

Mailing Address: ______Postal Code: ______

E-mail address: ______

Telephone: Cell: ______Home: ______Work: ______

Date of Birth (must be 18+ yrs): ______Gender Identity: ______

Emergency Contact: ______Phone: ______

Email: ______

*Please note: Persons who have accessed counselling services at SSAIC must wait 2 years from date of last contact to start date of Volunteer Training before applying.

General Information

Occupation (include unpaid work): ______

Present place of employment (include contact information): ______

______

Why did you choose our agency in particular at which to volunteer? ______

______

What goals do you wish to achieve by volunteering with our agency? ______

Previous volunteer or related experience: ______

______

List any skills, knowledge, resources, or experience you feel may be helpful in working with our agency: ______

______

Are you willing to work with male, female & transgender clients? ______

Would your views re abortion prevent you from being non-judgmental and supportive when interacting with a client? ______

How did you hear about the Saskatoon Sexual Assault & Information Centre? (volunteer, friend, school, radio, etc.): ______

When are you able to volunteer? Crisis Line shifts are as follows:

Weekdays: 9:00 a.m. – 5:00 p.m. _____ Weekends: 9:00 a.m. – 5:00 p.m. _____

Weekdays: 5:00 p.m. – 1:00 a.m. _____ Weekends: 5:00 p.m. – 1:00 a.m. _____

Weekdays: 1:00 a.m. – 9:00 a.m. _____ Weekends: 1:00 a.m. – 9:00 a.m. _____

List one character reference and two business, educational, or volunteer related references. State this person’s relationship to you (employer, clergy, family friend, etc.) Please do not use relatives. Give contact information for all references.

1. Name: ______Relationship: ______

Address: ______

Phone: (C) ______(H) ______(W) ______

Email: ______

2. Name: ______Relationship: ______

Address: ______

Phone: (C) ______(H) ______(W) ______

Email: ______

3. Name: ______Relationship: ______

Address: ______

Phone: (C) ______(H) ______(W) ______

Email: ______

Additional Comments and/or Dietary Issues