Volunteer At Envision
- It's So Rewarding -
ENVISION COUNSELLING AND SUPPORT CENTRE
Please mail, fax or email the application to:
Estevan, SK
S4A 2A5
Phone: 637-4004
Fax: 634-4229
To print this application:
Just highlight the entire application, then click the 'File' button, at the top left of your computer screen window, scroll down to print and select 'Print Selection'.
Or click here for the .pdf file of this application.
DATE: _________________________
FULL NAME: _______________________________
MAIDEN NAME: _________________________________
ADDRESS: __________________________________________________
__________________________________________________
E-MAIL: _______________________________________
POSTAL CODE: _______________
TELEPHONE: RESIDENCE: _______________ BUSINESS: _______________
DATE OF BIRTH: ____________________ (DAY/ MONTH/ YEAR)
SEX: _______
DO YOU HAVE ACCESS TO A CAR? ____ VALID DRIVER’S LICENSE?____
DO YOU HAVE A CRIMINAL RECORD FROM WHICH YOU HAVE NOT BEEN PARDONED?
YES _______ NO _______
EDUCATION AND RELATED TRAINING:
HIGHEST SCHOOL GRADE: _____
UNIVERSITY/COLLEGE:______________________________
OTHER:
_________________________________________________
EMPLOYMENT:
OCCUPATION:
_________________________________________________
PLACE OF EMPLOYMENT:
_________________________________________________
PREVIOUS WORK EXPERIENCE:
_________________________________________________
DO YOU HAVE ANY PREVIOUS VOLUNTEER EXPERIENCE? YES ____ NO ____
IF YES, PLEASE LIST:
1. ________________________________
2. ________________________________
3. ________________________________
4. ________________________________
DO YOU SPEAK, READ OR WRITE ANY LANGUAGE OTHER THAN ENGLISH?
_________________________________
WHY ARE YOU INTERESTED IN VOLUNTEERING WITH ENVISION AT THIS TIME?
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
VALUES AND ATTITUDES:
_________________________________________________________
_________________________________________________________
_________________________________________________________
DO YOU HAVE ANY PERSONAL OR PROFESSIONAL EXPERIENCE IN THE AREA OF FAMILY VIOLENCE?
YES _____ NO _____
If yes, please explain in what way:
____________________________________________________________
____________________________________________________________
____________________________________________________________
ARE THERE ANY TOPICS THAT MIGHT BE DIFFICULT FOR YOU DEAL WITH? (SEXUALITY, BI-SEXUALITY, HOMOSEXUALITY, MASTURBATION, ABORTION, SUICIDE, OFFENDERS, PEOPLE YOU KNOW)
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
DO YOU BELONG TO A RELIGIOUS, POLITICAL, OR PHILOSOPHICAL ORGANIZATION, OR HOLD CERTAIN BELIEFS THAT WOULD AFFECT OR INFLUENCE YOUR DIRECT SERVICE TO SURVIVORS? ______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
HOW DID YOU HEAR ABOUT THIS VOLUNTEER PROGRAM?
______________________________________________
WHEN WOULD YOU BE AVAILABLE FOR AN INTERVIEW?
(DAY/EVENING/WEEKEND)
WHAT TIMES ARE BEST FOR TRAINING? (DAY/EVENING/WEEKEND)
WHAT COMMITMENT ARE YOU WILLING TO GIVE AS A VOLUNTEER?
WEEKENDS:YES__ NO__ WEEKDAYS:YES__ NO__ EVENINGS: YES __ NO __
REFERENCES
PROFESSIONAL
NAME: ________________________________________________
POSITION: ____________________________________________
ADDRESS: _____________________________________________
PHONE: _______________________________________________
PERSONAL
NAME: ________________________________________________
ADDRESS: _____________________________________________
PHONE: _______________________________________________
RELATIONSHIP TO YOU: _________________________________
PLEASE FEEL FREE TO ADD ANY OTHER COMMENTS OR INFORMATION:
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
ALL THE INFORMATION GIVEN IS TRUE TO THE BEST OF MY KNOWLEDGE.
PRINT NAME:
__________________________________________________
DATE:
___________________________________________________
SIGNATURE:
___________________________________________________
