VOLUNTEER APPLICATION FORM ENGLISH

VOLUNTEER APPLICATION FORM
Date:
mm/dd/yy
Name

Family NameFirst Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone Home:
Please enter a valid phone number.
Telephone Cell:
Please enter a valid phone number.
Email:
example@example.com
Birth Date:

MonthDayYear
Current Employment Status:
For "Current Employment Status" please provide any other addition information:
Languages Spoken:
For "Languages Spoken" please indicate additional languages spoken:
Emergency Contact Information:
Volunteer Experience:
Please provide a brief description of any volunteer experience you may have.
REASONS FOR VOLUNTEERING, INTERESTS AND AVAILABILITY
Reason for Volunteering:

To help peopleTo Interact with peopleTo learnAcademic RequirementOther Requirement
For "Other Requirement" please indicate the requirement i.e. court ordered community service hours, etc.
Interests:

Friendly VisitsAccompainment to medical appointmentsShoppingOther
For "Interests" please provide any other addition information:
Please describe any specific skills(Computer, Music, Art, etc.)
Please type in which timeframes ( Morning/Afternoon/Evening) on which days you would be AVAILABLE to VOLUNTEER below:
How long are you willing to commit to being a volunteer ?
How many hours a week can your volunteer ?
Re: 1 hour, 2 hours, 3 hours, other
Please describe how you heard about EBM ?
Please describe any health restriction you have which might limit your ability to perform certain tasks and which you wish to be taken into consideration in the determination of your volunteer assignment:
VOLUNTEER'S DECLARATION
I declare that all tasks I will complete for Entraide Bénévole Métro will be done without remuneration. I promise to respect all regulations in effect to the performance of those tasks. I agree to undergo a police verification.
CONFIDENTIALITY AGREEMENT
As a volunteer, I understand that I am obliged to respect, within and outside this organization, the privacy of persons and the confidential nature of conversations and personal information involving clients or staff.

I declare that I have read this document, that I have understood its content and that I promise to respect it.
Please select the date that you signed this form
Please provide the date that you signed this form
dd/mm/yyyy
Please provide 2 pieces of Photo ID's below:

Cancelof
Volunteer References
Please provide two professional references (no family member or friend) that have known you for at least 6 months.
Reference #1:
Reference Name:
Relationship:
How long has this person known you ?:
Telephone and/or e-mail address:
Reference #2:
Reference Name:
Relationship:
How long has this person known you ?:
Telephone and/or e-mail address:
Should be Empty:

VOLUNTEER APPLICATION FORM

REASONS FOR VOLUNTEERING, INTERESTS AND AVAILABILITY

VOLUNTEER'S DECLARATION

CONFIDENTIALITY AGREEMENT

Volunteer References

Reference #1:

Reference #2: