Volunteer Application

Personal Information

Name*

Address*

City*

Postal Code*

Home Telephone*

Business Telephone*

Email*

Birth Month

Languages*

English
French

Langauges - Other

Are you a Francophone?*

Yes
No

Emergency Contact

Name*

Telephone*

Relationship*

Volunteer Information

How many hours per week would you like to volunteer?*

Please enter a number greater than or equal to 0.

When are you available to volunteer?

Morning

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Afternoon

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Do you have any special needs that need to be taken into consideration when selecting a suitable volunteer position?*

Yes
No

If yes, please explain

How did you hear about us?*

EMC Kanata Kourier
EMC Nepean
EMC Stittsville
Web search
Friends
WOCRC website
Other

What volunteer programs/positions would you like to be involved in?*

Skills and Experience

Volunteer and/or paid work experience*

Special Skills / Talents / Education or Training*

Affiliations within the Community

Please identify any service clubs that you are affiliated with in the community*

Character References

Please do not use immediate family members such as: spouse, parents, siblings, etc.

Please list two character references:

Name #1*

Telephone #1 - Day*

Telephone #1 - Evening*

Email #1*

Name #2*

Telephone #2 - Day*

Telephone #2 - Evening*

Email #2*

Comments

This field is for validation purposes and should be left unchanged.