Volunteer Application
Contact Information Date Rec’d: Initials:
NameStreet Address / City/Postal Code
Home/Cell Phone / E-mail Address
How did you hear about the Rose of Sharon?
Why do you want to volunteer at the Rose of Sharon?
q To get involved in my community / q To support young mothersq To gain experience for work or school / q Other (explain):
q To earn community volunteer hours
In which areas are you interested in volunteering?
q Child Development Center / q Seasonal (Christmas)q Food/Clothing Bank (Rosie’s Closet) / q Special Events/Fundraising
q Reception / q Other:
Availability (During which days & times are you available for volunteering? Please select all that apply)
q Mornings 9:00am-12:00pm / (Please circle) Mon Tue Wed Thu Friq Afternoons 12:30-4:00pm / (Please circle) Mon Tue Wed Thu Fri
q Evenings 4:00-6:30pm / (Please circle) Mon Tue Wed Thu Fri
Related Work & Volunteer Experience (Current or past)
Paid word, student placements, training programs or volunteer.
Name of Organization / Position Duties / From (mm/yy) - To (mm/yy)
Education (highest level of education completed OR in progress)
__ Degree/Certificate ___ Undergraduate Degree __ Post-graduate
__High School ___Diploma/Certificate __ None apply / Area of Study:______
List any additional courses, skills, interests, hobbies, special qualifications or other experiences you feel are relevant for the volunteer position in which you are applying:
Do you have any health related issues that may impact on you volunteering with us?
(Please circle) No Yes If yes, please explain:References (please provide two references of people we may contact for a character reference. If possible, please include email as well)
1. Name:
Phone:
Email:
Relationship: / 2. Name:
Phone:
Email:
Relationship:
DECLARATION:
Before signing and dating below, please read and initial to indicate you agree with each section.
_____ I certify that I am 18 years of age or older.
_____ I certify the information in this application is correct to the best of my knowledge.
_____ I understand that any misrepresentation or omission may result in my dismissal.
_____ I understand that not everyone who applies is accepted into the Volunteer Program.
_____ I hereby authorize Rose of Sharon to contact and obtain references in connection with my application for volunteering.
_____ As a condition of volunteering, I understand that a Vulnerable Sector Police Record Check is completed, to which I am responsible for covering any associated fees.
_____ As a condition of volunteering, I agree to provide results of the required Volunteer TB Medical test when if my position involves working directly with the children at Rose of Sharon. I am responsible for covering any associated fees for this test.
_____ I agree to complete all mandatory training required by Rose of Sharon.
_____ I will adhere to the policies and procedures of Rose of Sharon as they are provided in written or verbal instructions.
_____ I agree to respect the confidentiality of all information to which I may have access at Rose of Sharon and to sign off on the Confidentiality form.
_____ I understand that violation of confidentiality provisions could result in immediate dismissal from Rose of Sharon volunteer programs.
Agreement and Signature
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that, if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.Name (printed)
Signature / Date:
Thank you for completing this application form and for your interest in volunteering with us. Your privacy is important to us and we are committed to protecting and safeguarding your personal information.
Please email completed form to Tamar Dobner, Community Engagement Coordinator