CMHA - Eastern Branch: Volunteer Form

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Volunteer Form

Volunteer Application Form

Name:	_________________________________________		Date:	_____________________
Mailing Address:	_________________________________________		Apartment:	_____________________
	_________________________________________
Telephone Home:	_________________________________________		Business:	_____________________
Languages:	Spoken English French		Written English French

Type of Volunteer work desired:
		Board or committee work
		Bingo (assists with ticket sales, counter help)
		Collective Kitchens (assist with meal planning and preparation )
		Public Education Activities (Booth, displays, public speaking, campaign promotion)
		Peer Resource Centers (opening center, welcoming clients, assist with group activities)
		Office Clerical work
		Fundraising Campaigns (golf tournament)
	Other:	_________________________________________________________________

Location:	Cornwall	Alexandria	Hawkesbury	Winchester	Casselman
Availability:	______________________________________________________________________________
Volunteer/Work Experience:	______________________________________________________________________________
	______________________________________________________________________________
	______________________________________________________________________________

In the event of an Emergency
Name:	_________________________	Tel.:	_________________________	Relation:	_________________________

References:
1) Name:	_________________________	Tel.:	_________________________	Relation:	_________________________
2) Name:	_________________________	Tel.:	_________________________	Relation:	_________________________
3) Name:	_________________________	Tel.:	_________________________	Relation:	_________________________
I consent to having the above references checked: ________________________				Date: ___________________________

Interview:	_________________________	References Checked:	_________________________	Sat. Unsat.
Police Check:	_________________________
Accepted for Volunteer: ________________________________			Start date: _________________________
Vol. Rec.:	CMHA Volunteer Handbook Orientation Signed Confidentiality Form
	Training provided by:	__________________	Program Supervisor:	__________________
	Informed of reporting mech. _____________________________________________

Comments ______________________________________________________________________________________________

Revised April 2007