VOLUNTEER APPLICATION FORM 128 St. Vincent Street Barrie, ON L4M 3Y8 Tel: 705-722- 5221 Fax: 705-722-5082 [email protected]Registered with the Canada Revenue Agency Registration No. JOB INFORMATION Position Location Date Received: Date Interviewe d: Adult Volunteer Student Volunteer Camp Promise@ Bethel 128 St. Vincent Street Barrie ON L4M 3Y8 Contact: Tracy Robinson Cell: 705-726-9778 Email: PERSONAL INFORMATION Last Name First Name M.I Street Address Apart/Unit City Postal Code Home Phone Cell Phone Email Health Card # Date of birth Church name (if applicable) Current School/Workplace Grade level EMPLOYMENT/VOLUNTEER HISTORY Date Employer/Supervisor Job title/Volunteer position REFERENCES Full Name Relationship Phone Email AVAILABLITY What days are you available? What age group would you like to work with? Children (ages 5-10) Youth (ages 11-14) Wednesday 3pm – 7pm Thursday 3pm – 7pm Saturdays - part day (relationship Sundays (helping bring children to
Transcript
VOLUNTEER APPLICATION FORM
128 St. Vincent Street Barrie, ON L4M 3Y8 Tel: 705-722-5221 Fax: 705-722-5082 [email protected] with the Canada Revenue Agency
Registration No. 128793049RR0001
JOB INFORMATIONPosition Location
Date Received:
Date
Interviewed:
Start Date:
Adult Volunteer Student Volunteer
Camp Promise@ Bethel128 St. Vincent StreetBarrie ON L4M 3Y8Contact: Tracy RobinsonCell: 705-726-9778Email: [email protected]
PERSONAL INFORMATION
Last Name First Name M.I
Street Address Apart/Unit City Postal Code
Home Phone Cell Phone Email
Health Card # Date of birth Church name (if applicable)
Current School/Workplace Grade level
EMPLOYMENT/VOLUNTEER HISTORY
Date Employer/Supervisor Job title/Volunteer position
REFERENCES
Full Name Relationship Phone Email
AVAILABLITY
What days are you available? What age group would you like to work with?
Children (ages 5-10)
Youth (ages 11-14)
Wednesday 3pm – 7pm
Thursday 3pm – 7pm
Saturdays - part day (relationship building)
Sundays (helping bring children to church at Bethel)
VOLUNTEER APPLICATION FORM
128 St. Vincent Street Barrie, ON L4M 3Y8 Tel: 705-722-5221 Fax: 705-722-5082 [email protected] with the Canada Revenue Agency
Registration No. 128793049RR0001
ADDITIONAL INFORMATIONPlease check all experience/qualifications you possess:
Please provide a brief narrative of your spiritual life story (if applicable):
Describe any experience you have in working with a team?
Describe your strengths/skills/talents that are applicable to working with children and youth?
Describe any weaknesses?
Describe briefly what you know about working with children/youth at risk?
Child/youth work Christian ministry Leadership Planning Working with non-profit organizations Arts and crafts
Community development First Aid/CPR Social Work Camp/club experience Musical abilities Sports OTHER
VOLUNTEER APPLICATION FORM
128 St. Vincent Street Barrie, ON L4M 3Y8 Tel: 705-722-5221 Fax: 705-722-5082 [email protected] with the Canada Revenue Agency
Registration No. 128793049RR0001
MEDICAL / HEALTHAt Camp Promise, providing a safe environment for our children and youth is paramount. As such, we endeavour to be as forthcoming as possible with the stresses a person can expect to experience in our environment. We also ask that applicants are upfront with Camp Promise about past or current struggles and/or medical conditions.Please be aware that, in some circumstances, further documentation may be required. Anything not disclosed that may affect the safety of teammates or children can be grounds for removal from the volunteer position.
Information provided in the following section is kept in strict confidence.
Do you have a history or past incidents of:
a. Emotional difficulties
b. Medical/physical conditions
Please check off any of the following conditions or experiences that have occurred or that you suspect may be true for you (even if it has not been medically diagnosed )
Condition/experience YES NO If yes please provide more information
Depression
Eating Disorder (e.g Anorexia, Bulimia etc)
Anxiety
Chronic Fatigue
Allergies
ADD/ADHD
ODD
Self Injury (e.g Cutting)
Anger Management
Abuse: Physical, Emotional, SexualAre you currently on any medication YES/NO (Please list with reason for use)
I certify that all answers provided in this form and during the interview are true and complete. I understand that providing false or misleading information, or the omitting of information, may be grounds for rejecting my application or, if hired, may result in dismissal.
