Volunteer Opportunities

Date of Application(Required)

Name(Required)

Home Phone(Required)

Work/Cell Phone

Address(Required)

Postal Code(Required)

Volunteer Position Applying to(Required)

Transportation

Transportation
Meals on Wheels
Adult Day Program
Friendly Visitor

Why do you want to volunteer? Or, what do you want to gain from this volunteer experience?(Required)

Do you have a driver's license?(Required)

Yes

License Class

Do you own your own vehicle?

Yes

Would you be interested in providing transportation?

Yes

Educational history, including names of schools and highest grade completed(Required)

Have you completed any additional educational programs or special training? If so, briefly describe (Extension, Night School, Correspondence, etc.)(Required)

Plans for further study, if any

If you have any further skills, please describe

Please list your hobbies and interests(Required)

Employment History

Please start with your most recent job.

Employer(Required)

Address

Position(Required)

Reporting to

Date commenced

Date left

Employer

Address

Position

Reporting to

Date commenced

Date left

Would you like us to keep your employer abreast of your volunteer service and achievement?

Yes

Do you belong to any groups, clubs, or have any organizational memberships?(Required)

Please describe your prior volunteer experience (include organization name and dates of service).(Required)

What life experiences have you had that may prepare you to work as a volunteer with older adults and adults with developmental disabilities?(Required)

References

Please provide two (2) references. Relatives cannot be used as a reference.

Name(Required)

Address

Phone(Required)

Occupation

Name(Required)

Address

Phone(Required)

Occupation

Availability

Please indicate your availability each day of the week and to be on call, as well as when your preferred time is. If you are unavailable on a certain day, please leave it blank.

Sunday

Morning

Afternoon

Evening

Monday

Morning

Afternoon

Evening

Tuesday

Morning

Afternoon

Evening

Wednesday

Morning

Afternoon

Evening

Thursday

Morning

Afternoon

Evening

Friday

Morning

Afternoon

Evening

Saturday

Morning

Afternoon

Evening

On call

Morning

Afternoon

Evening

Acknowledgement

I understand that this is an application for and not a commitment or promise of volunteer opportunity. I certify that I have provided and will provide information that is true, correct, and complete to the best of my knowledge throughout the selection process, including on this application for a volunteer position and in interviews with Dufferin County Community Support Services. I certify that I have answered and will answer all questions to the best of my ability and that I will not withhold any information that would unfavorably affect my application for a volunteer position. I understand that information contained on my application will be verified by Dufferin County Community Support Services. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant for a volunteer position with Dufferin County Community Support Services or my termination as a volunteer.

I have read and understand the acknowledgement above.

Yes

The personal information collected on this form is collected in Accordance with Section 27 of the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, c.M.56, as amended, and will be used to determine the applicant's eligibility as a volunteer. Questions about this collection should be directed to the Clerk at 30 Centre Street, Orangeville, ON L9W 2X1 or 519-941-2816 ext. 2504.

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At Dufferin County Community Support Services (DCCSS), our volunteers are an integral part of our team.

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Employment History

References

Availability

Acknowledgement