VOLUNTEER APPLICATION FORM ENGLISH

VOLUNTEER APPLICATION FORM
Date:
mm/dd/yy
Name*

First NameFamily Name
Gender (Pronoun)*

Woman (She/Her)Man (He/Him)Non-binary (They/Them)Other
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone Cell:*
Please enter a valid phone number.
Telephone Home:
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 appointmentsShoppingTech HelpOther
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 or specific hours) 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 ?*
I.e. 2 hours, 3 hours, 4 hours... Note: Minimum 2 hours
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:
Do you have a monthly STM OPUS card? (This has no bearing on eligibility)*

YesNo
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:*

Please provide 2 pieces of Photo ID
Cancelof
Volunteer References
Please provide two references (no family member or friend). Your references must have known you for a minimum of 6 months in a professional, academic, or volunteering capacity. References can be based outside Montreal. Should you provide a reference outside of Canada, please provide an email as a means of contact.
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:*
Have you ensured that your references are NOT friends or family members?*

Yes
Should be Empty:

VOLUNTEER APPLICATION FORM

REASONS FOR VOLUNTEERING, INTERESTS AND AVAILABILITY

Volunteer References

Reference #1:

Reference #2: