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CHALMERS COMMUNITY SERVICES CENTRE 40 Baker Street, Guelph, ON N1H 4G1 519-822-8778 E-mail: volunteer@chalmerscentre.ca www.chalmerscentre.ca Volunteer Application Form CONFIDENTIAL Name: Address:

Email:

Mailing Address (if different from above): Phone: Emergency Contact and Phone Number:

Alt. Phone:

Work/Volunteer Experience (Please attach a resume if you have one) Previous and Current Volunteer Experience:

Relevant Work Experience:

Special Skills/Interests/Hobbies: □ Computers (Specify Programs)____________________________ □ Fundraising □ Sorting and Organizing (food, clothing and household items) □ Committee Work □ Public Speaking □ Driving (food pick ups) □ Facilitating Workshops (please indicate subject matter ____________eg. budgeting, food preparation, nutrition, active listening)

Other:

Availability Location Chalmers Downtown – 40 Baker St.

Time Wednesday 6:30-8:15pm

Chalmers Downtown – 40 Baker St.

Friday 8am-12:15pm

Yes

No

Chalmers West – 577 Willow Rd. Thursday 9am-12pm Please indicate any other times you are available should we need additional help outside of program times.


Additional Information: How did you find out about us? Why would you like to volunteer with Chalmers Community Services Centre

References (Please notify these people in advance that we will be contact them) Name 1.

Address

Phone Number

2 . 3 . To be signed at first volunteer session: I agree to participate in orientation and training session as required. I agree to respect the confidentiality of all information I may have access to. Date: _____________________ Signature: ________________ OFFICE USE ONLY Interviewed By____________________ Date__________________ References Comments 1._____________________________________________________________________________ 2._____________________________________________________________________________ 3._____________________________________________________________________________ Police Record Check returned: _yes _no Record Shown: _yes _no Follow Up: _yes _no Volunteer Accepted: _yes _no Start Date__________________________ Position _________________________ Training/Orientation Completed: Date:_________________ Date for review/training:_____________________________ Exit Date:___________ Reason:_________________________________________


Volunteer Application Form