Volunteer Application Form

Please complete the form below.  Answer all questions to the best of your ability.  * Indicates mandatory field.

Identification

Last Name: *
First Name: *
Maiden Name or
Previous Surname

Contact Information

Home Phone: *
Work Phone: *
Cell Phone: *
Email: *

Home Address

Address: *
Apt #:
City/Town: *
Postal Code: *

Questionnaire

Are you over the age of 18?   Yes:   No:  *

Where did you hear about volunteering for the Distress Centre Oakville?

If you saw our ad on a Mobile Sign, please indicate the location of the sign:

Are you able to commit to a minimum of three shifts per month?   Yes:   No:  *

Do you have previous experience that you think would be helpful to you
in working at the Distress Centre (work or volunteer experience?)  Please specify: *

Why do you want to work at the Distress Centre? *

Please list any relevant training courses you have taken.
(Note: not a prior requirement.  A training course will be given by the Distress Centre). *

List three occupations you have had, starting with the present. *

List any interests or skills, which could be of benefits to the Centre
in areas other than the distress line, e.g. public speaking, artistic or computer skills, etc.

Do you speak a language other than English?  If so, what do you speak?

Have you had any personal stressful situations in the past year and a half? *

Are you currently suffering from any illness that might affect you
work at the Distress Centre, e.g. hearing problems or heart trouble? *

Are you currently in counselling or therapy?   Yes:   No:  *

Do you know anyone who works at the Distress Centre?

What do you think you will be doing at the Distress Centre?

What types of problems do you think we deal with?

What personal qualities do you think you will bring to the Distress Centre?

What personal enrichments do you think the Distress Centree will bring to you?

Training is scheduled for one weekday evening per week for seven (7) weeks.
Is there any evening that you would not be available?

The Distress Centre Oakville operates on a volunteer basis.  However, we would count on you to consistently
show up for shifts when you are scheduled.  Do you have access to a reliable means of transportation?

 Yes:   No:  *

Date Application Submitted: 2012-05-18