Application Form

Thank you very much for your interest!
Please complete and submit this form

Please put your needs first. If you are currently experiencing, or have recently experienced a stressful life event please place your need for support above the desire to give your support at this time.

First Name:

Last Name:

Street Address:

Postal Code:

City:

Home Phone Number:

Fax Number:

Business Phone Number:

Business Fax Number:

Email Address:

Present Occupation:

Languages Spoken:

Experiences Had as a Volunteer:

Do you possess any special skills or abilities that will be helpful to you as a volunteer?
If so, what are they?

Why Do You Wish To Volunteer at the Distress Centre?

What type of qualities do you think a person would need to work at a Distress Centre?

Briefly describe your work experience(s):

How did you find out about the Distress Centre Niagara?

Will you require a letter acknowledging your work at the Distress Centre?
Yes No

Please Provide Three References:

Examples of appropriate references are employers (past & present), co-workers, teachers, supervisors from other volunteer work etc. (no family references please).

**** Please ensure references you provide are aware we will be contacting them****

To allow references the opportunity to reflect on responses to our questions about perspective volunteers we have developed a standard request form. This form will be mailed or sent via email to each of your references. Therefore, please ensure that you have provided either a mailing address or email for each of your references. Should your submission not include one or both of these items it will be returned to you for completion.

1.

Name:
Mailing Address:
Telephone:
Email:
Relationship:

2.

Name:
Mailing Address:
Telephone:
Email:
Relationship:

3.

Name:
Mailing Address:
Telephone:
Email:
Relationship:

When would be a convenient time to contact you to further discuss your interest in volunteering with Distress Centre Niagara?
Day Evening

Where Can We Reach You?
Home Phone Business Phone

The following questions would be helpful for you to consider before choosing to begin the process of volunteering with Distress Centre Niagara:

• Are you aware that volunteers are not to put forth any personal, political or religious points of view to callers?
• Are you willing to accept that callers will often have very different values and moral beliefs than your own?
• To what extent will your commitment to meet our shift requirements interfere with your personal schedule?

Thank you for taking the time to fill out this form