| General application | |
| Name | |
| Address | |
| | |
| City | |
| Province |
|
| Postal code | |
| Home telephone | |
| Work telephone | |
| Fax | |
| Email address | |
| Emergency contact | |
| Emergency contact Relationship | |
| Emergency contact Tel Home | |
| Emergency contact Tel Work | |
| Languages | |
| | English |
| | French |
| | Sign |
| | Bliss Symbols |
| Skills & Interests | |
| Educational background | |
| Current employer | |
| Work experience | |
| Hobbies, skills, interests | |
| Previous volunteer experience | Yes No |
| If yes, name of organization | |
| Have you ever served as a volunteer with us before? | Yes No |
| Name and telephone number | |
| Preferences in volunteering | |
| | No preference |
| | Working one-on-one with a single client (movies, walking, shopping, physical fitness, etc.) |
| | Providing assistance to several clients |
| | Driving clients |
| | Swimming Assistant |
| | Special occasions |
| | Painting |
| | Gardening |
| | Silver Spring Farm Garlic Project |
| | Christmas Gift Wrap |
| What are your hesitations, if any, to develop a relationship with a person who has a developmental disability? | |
| Would you prefer Male or Female? | |
| Would you feel comfortable being matched with an adult with limited to no verbal skills? | |
| Do you have any physical disability or illness, which would need to be considered in any volunteer position? If yes, please specify: | |
| Have you been immunized against Hepatitis B? | Yes No |
| If there's a geographic area in which you'd prefer to do volunteer work, please indicate your prefererence here: | |
| Do you have access to a vehicle that you can use for volunteer work? | Yes No |
| | |
| References | |
| Please list two non-family references that you have known for two years that we may contact. | |
| 1st reference | |
| Name | |
| Home telephone | |
| Email address | |
| | |
| 2nd reference | |
| Name | |
| Home telephone | |
| Email address | |
| | |
| You heard about us from | |
| | a staff member |
| | the Volunteer Center |
| | a friend / volunteer |
| | a client of the OCAPDD |
| | the Volunteer Marketplace |
| | other (please specify): |
| | |
| Authorization | |
Please check here if you agree to the following:
I, hereby give permission to the Ottawa-Carleton Association for Persons with Developmental Disabilities to contact the references listed in regards to my volunteer application. I understand that a police background and driving record check will be conducted as required. |
| | |
| Photo Release | |
Please check here if you agree to the following:
I hereby release any claims to all film, video audio or digital photos or recordings of / or involving myself, taken for publicity purposes and / or display opportunities for OCAPDD. This includes release of rights to broadcast, reprint, display, include in any brochure or promotional material, or for any other form of distribution or reproduction. Any of these visual or audio materials involving myself and/or others will become the property of OCAPDD. |
| | |
| Declaration | |
Please check here if you agree to the following:
I, hereby declare that the information provided on this form is correct to the best of my knowledge and I understand that any false statement may disqualify me from acceptance into the volunteer program. |
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