CCSS Volunteer Application Form

Volunteer Application Form
Personal Information
Name*

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

MonthDayYear
Date
Age
Auto calcuated
Primary Contact Number*
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*
Relationship to you*
Main Language*
Skills & Availability
Which programs/ support are you interested in volunteering:*

Community Volunteer Income Tax ProgramAdministrative SupportConnections Arts & Music ClubBookkeeping SupportConnections Sports ClubEvent and Program Coordination SupportDigital Literacy Program for SeniorsFocus GroupsEnergy Conservation Assistance ProgramFundraisingGenerations Homework Club (Mentors for Elementary & Secondary students)Human Resource SupportIndigenous ProgramsMarketing & Communications SupportPublic Speaking WorkshopsSocial Media Platform SupportSenior Support ProgramsVolunteer Management SupportSpecial Projects - Senior Magazine PublicationSpecial Projects - Truth & Reconciliation CeremonySpecial Projects - Stay-in-School Award CeremonySpecial Projects - Volunteer Recognition Awards
Skills*

AccountingAdministrationArts / MusicBuilding and RenovatingChildcareCoachingCounsellingCustomer RelationsFinancial AidFirst AidFundraisingGraphic DesignIT / ComputerLaw & Human RightsMarketingPhotographySpecial NeedsTeachingWritingPublicationTranslation
Other Area of Interests / Talents

Availability (Please check all that apply)*

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

Additional Information
What is your desired length of commitment? *
Please upload a copy of your resume for reference*

Accept only PDF, doc and docx format
Cancelof
Medical Conditions
Do you have any medical conditions?*

YesNo
If yes, please describe the condition in detail in the space below:*
Do you have any food allergies or specific dietary needs?*

YesNo
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.*

YesNo
Have you ever been investigated for child or dependent abuse or neglect?*

YesNo
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?*

YesNo
Waiver of Liability and Photo Consent
Signature*

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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*

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Volunteer Application Form

Personal Information

Emergency Contact

Skills & Availability

Medical Conditions

Statement of Purpose

Self-Disclosure of Criminal Background

Waiver of Liability and Photo Consent

Parental/Guardian Consent