SCPC Volunteer Application Form

Your Name*

First NameMiddle NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Phone Number*

Do you need accommodation services in order to perform your duties?*

YesNo

Please enter what type of accommodation services do you need.*

Emergency Contacts*

Birthdate*

Date

How did you find this volunteering program?*

General Availability Information*

	From	To
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Why do you want to be a volunteer for the Strathcona CPC?*

Please tell us about any other volunteering experiences you have had.*

What do you expect to gain from volunteering with the Strathcona CPC?*

Do you have access to the internet at home?

YesNo

Are you considering a career in the police force or alternative law enforcement agency?

YesNoNot sure

Please provide 3 character references*

	Name	Relationship to you	Phone/Email
Reference #1
Reference #2
Reference #3

DECLARATION OF CONFIDENTIALITY

I hereby affirm that in my position as a volunteer with the Strathcona Community Policing Centre I will be handling confidential information and will not discuss this information outside of the SCPC. I will exercise due care with the information I provide to citizens. If I have questions regarding the disclosure of information to the public I will consult the Neighbourhood Police Officer or SCPC staff.

I understand that no document is to be copied and/or removed from the Strathcona Community Policing Centre without the permission of the Neighbourhood Police Officer or SCPC staff.

Further, I agree that any knowledge gained because of my position or my presence within the CPC office or the Vancouver Police Department will remain confidential. I will exercise due care that the information I provide to others is the information they are entitled to.

I will not discuss specific facts and/or any personal data concerning victims, witnesses and other clients I serve with members of the media, private citizens or other victims or witnesses.

I understand that I cannot promise complete confidentiality to any victim or witness to whom I provide service, in that under rules of evidence, I may be subpoenaed to appear in Court and give testimony, and will advise clients of this fact.

I will not discuss my services with any member of the media or write about my experience with the Strathcona CPC without prior approval of the Neighbourhood Police Officer or Executive Director.

I have read the above “Confidentiality Affirmation” and agree to the above statements. By signing below, I hereby agree to the conditions set above. I understand that a violation of any of the above conditions may result in my dismissal as a volunteer.

Volunteer Candidate Signature*

Date