Volunteer Application Form

Please return this form electronically if possible. If completing by hand, please print clearly. All information gathered will be kept confidential and will only be used by the Township of Champlain.

Last Name

First Name

Address

City

Province

Postal Code

Home Tel.

Work Tel.

Cell.

Email

Do you have a valid driver's licence?

Yes

No

Driver's licence number

Have you ever been convicted of an offence under the Youth Criminal Justice Act or adult law?

Yes

No

Areas of Interest

Please rank your volunteering task preferences (choice 1,2,3)
Note that not all tasks are available at all times and in all areas.

Children's Activities

Teen/Adult Activities

Service to Clients

Special Events

Security

First aid

Focus Group

Other

Previous Experience

Have you previously volunteered with the Township of Champlain

Yes

No

Have you previously worked for the Township of Champlain?

Yes

No

What training or qualifications do you have (e.g. photography, accounting...)?

Commitment

Less than 6 months

6 months to a year

Ongoing

Other (please specify)

References

Please provide the names and telephone numbers of three references.

Reference

I certify that the information in this form and attachment(s) is correct and complete. I understand that I will be advised if a criminal record check, a driver's abstract and/or other program specific checks may be required.

Applicant's Signature

Date

* Applicants under the age of majority must have a parent/gardian fill out the following:

I am aware of and support my child/legal dependant's decision to volunteer with the Township of Champlain.

Name:

Relationship to applicant

Telephone number