CCSS Volunteer Application Form

Volunteer Application Form
Personal Information
Legal Name

First NameLast Name
Preferred Name
Name that you prefer us to call you
Date of Birth

MonthDayYear
Date
Age
Auto calcuated
Primary Contact Number
Format: (000) 000-0000.
E-mail
example@example.com
Address
City
Postal Code
Main Language
Other Language(s)
Education Level
School
Grade
Length in Canada (Years)
Country of Origin
How did you learn about us?
For other, please specify:
Emergency Contact
Name of Emergency Contact

First NameLast Name
Emergency Contact Number
Format: (000) 000-0000.
Relationship to you
Main Language
Availability & Skills

Availability (Please check all that apply)

Rows	SUN	MON	TUE	WED	THU	FRI	SAT
9am-12nn
12nn-3pm
3pm-6pm
6pm-9pm

Please upload a copy of your resume for reference

Accept only PDF, doc and docx format
Cancelof
Which programs / support are you interested in volunteering in general?
Skills
Other Area of Interests / Talents / Additional Information
What is your desired length of commitment?
Medical Conditions
Do you have any medical conditions?
If yes, please describe the condition in detail in the space below:
Do you have any food allergies or specific dietary needs?
Please describe i.e., vegan, vegetarian, does not eat pork, lactose intolerant, peanut allergy, etc.
Statement of Purpose
What makes you interested in becoming a volunteer?
What draws you to our specific organization and/or project area?
What are your career goals as a volunteer?
Can you use a statement to describe what volunteering means and why it’s meaningful to you?
Can you tell me a fun fact about you?
Self-Disclosure of Criminal Background
Have you been convicted of a crime; which includes felony, or misdemeanor (speeding and parking violations excluded)?All alcohol- and/or drug-related violations must be reported. “Conviction,” as used in this provision, includes a criminal proceeding where a finding or verdict of guilt is made or returned, but the adjudication of guilt is either withheld or not entered, or a criminal proceeding where the individual enters a plea of guilty.
Have you ever been investigated for child or dependent abuse or neglect?
Required Additional Information: If your answer is YES to either or both items 1 and 2, you are required to fully explain the situation (include date of incident(s), nature of crime, city and state of occurrence, and sentence or rehabilitation requirement) in the space below. Your application will not be considered if you do not provide the information required.
Are you willing to provide your Criminal Record Check if you are invited to be our volunteer?
Waiver of Liability and Photo Consent
I give the permission to CCSS to take pictures of myself for promotional materials, website images, or reports developed by the agency. CCSS respects the rights and privacy of volunteers and participants and will delete any photos of the volunteer or participant upon request.
Signature
Parental/Guardian Consent

Necessary if the applicant is under the age of 18
I First Name Last Name , hereby authorize my child, First Name Last Name to participate in program activities of
Connections Community Services Society (CCSS).
By signing this form, I am stating and confirming that I am his/her legal parent/guardian and that:
Name of the Parent/Guardian

First NameLast Name
Signature
Today

MonthDayYear
Date
Should be Empty:

Volunteer Application Form

Personal Information

Emergency Contact

Availability & Skills

Medical Conditions

Statement of Purpose

Self-Disclosure of Criminal Background

Waiver of Liability and Photo Consent

Parental/Guardian Consent