Volunteer Application Form Volunteer Application Form First Name* Last Name* Gender Male Female Other Address* City/Town* Province* Postal Code* E-mail* Home Phone Business Phone Cell Phone I prefer to receive calls at: Home Business Cell Best time to call? Are you over 18 years of age? Yes No Please list education, training and skills that may relate to ImagineAbility Support Services Please check if you have the following valid documents: Clear Criminal Record Check Clear Child Abuse Registry Check Clear Adult Abuse Registry Check MB Drivers License Currently I am: Employed Unemployed Retired Student Other Please list employers that you currently work for or have worked for in the past. Employer 1 Job Title Date Started Date left Reason for leaving Employer 2 Job Title Date Started Date left Reason for leaving Volunteer WorkPlease list organizations that you currently are volunteering for or have volunteered for in the past. Volunteer organization 1 Date started Date left Reason for leaving Volunteer Organization 2 Date started Date left Reason for leaving Have you ever applied to volunteer with ImagineAbility before? If yes, when? Is there a specific volunteer role that you are interested in? Please describe. Please indicate your reasons for volunteering Academic Credit Help Others Stay active and involved Increase self-esteem Relative/friend of service user Learn new skills Employment Experience Explore Careers Practice English Skills Improve Social Services Social Interaction Other Please indicate how you found out about our volunteer program? Family Member Referral Organization Poster/Brochure/Flyer Employee Volunteer Centre Radio/TV Internet Search Friend Other When and what days are you available? How many times a week would you like to volunteer? 1 shift 2-3 shifts 4 or more Are you interested in volunteering for special projects and events? Yes No Are there times of the year you are not available to volunteer? If you wish to have anything further to be taken into consideration when determining a volunteer placement (for example: mobility issues, back problems or allergies), you may list those issues here: Who would you like us to contact in case of an emergency? Name Home Phone Work Phone Cell Submit Reset
