VOLUNTEER APPLICATION FORM

The information collected here will be used to place you in an appropriate volunteer position.

This information will be kept on file for the time period, as required by the legislation of Ontario.

Date: ______

(Day/Month/ Year)

Mr./Mrs./Ms. ______

(Circle One)(First)(Last)

Current Address: ______

(Street)(City) (Province) (Postal code)

Telephone – Home: ______

Other: ______

E-mail Address: ______

Date of Birth: ______

(Day/Month/Year)

Current Employer: ______

(Position)

Have you ever been convicted of a felony? Yes No

What position are you most interested in? ______

Have you had previous volunteer experience?  Yes No

I am interested in volunteering:  Days Evenings Weekends

 Monday  Tuesday  Wednesday  Thursday  Friday  Saturday  Sunday

Are you currently a student:  Yes No If so, where ______

Rate Your Computer Skills: (Low to none)1 2 3 4 5 (extremely proficient)

Do you speak any other languages: ______

Reason for wanting to volunteer: ______

______

______

Are service hours for school/agency/service project or other?  Yes No

If other please specify: ______

If yes, please provide name of school/agency contact information: ______

______

How many hours are required for service? ______Completion Date: ______

Emergency Contact Information

In case of an emergency, contact: ______Relationship: ______

Telephone – Home: ______

Business or Cell: ______

References:

Please print TWO personal references name and contact information.

1. (Mr./Mrs./Ms)______Telephone:______

Email: ______

2.(Mr./Mrs./Ms)______Telephone:______

Email: ______

Confidentiality Statement:

I, the undersigned, promise to hold in confidence all matters that come to my attention as a volunteer at University Settlement. This includes materials from and about clients, matters regarding colleagues, and other confidential information about the organization. I will respect the privacy of the people I work with, and confer appropriately with my supervisor(s).

Initials: ____

Privacy Statement:

We protect your personal Information and adhere to all legislative requirements with respect to privacy. We use your personal information to keep you informed and up to date with agency activities and its specific programs including but not limited to; opportunities to volunteer, upcoming events, educational opportunities and our annual volunteer appreciation event.

Initials: ______

The following information may be required when it is applicable to the job description being performed by the volunteer

Criminal Records Check, Vulnerable Sector Records Check, Drivers Licence, Liability Waiver, First Certificate, Medical Immunization Record, Agreement to US policies and Procedures

Please Read Before Singing below:

I understand that this is only an application form and not a commitment or promise of volunteer opportunities with US. I certify that I have and will provide information throughout the selection process, including this document, that I will provide true and accurate information. I certify that I have and will answer all questions honestly and will not withhold any information that would unfavorably affect my application for a volunteer position. I understand that information received on within my application will be verified. I understand that omissions and or misrepresentation will be cause to stop the process and or can end the volunteer opportunity immediately.

Name of Applicant: ______

(Please Print)

Signature of Applicant: ______Date: ______

Please Attach a copy of your resume to this application for your file.

Please return final copy of this application to Sharon McCalla, HR, and Volunteer Coordinator.

If you do not wish to be included in the Annual Report Volunteer list, please check here

If you are not comfortable having your picture in the Annual Report, please check here

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