Cochrane-Smooth Rock Falls VCARS Victim Services

(705) 272-2598     24 hours 1-877-264-4208

French
What is VCARS?
About us
Services
Volunteer
Volunteer Application
Board_of_Directors.htm
Who is a Vicitm & What is a Crisis
Vicitms Bill of Rights
What Can Victims Expect
Critical Incident Stress Management
Victim Quick Response
Provincial Site
Volunteer Application

GENERAL INFORMATION

(Mr., Mrs., Ms., Miss) Surname:_________________________

Given Name _______________________ Middle name(s): _________________________

Maiden Name  ____________________________

Home Telephone # ________________________ Business Telephone # _________________________
Complete Street and Mailing address: _________________________________________________________________________ ______________________________________________________________________________
Is it convenient to contact you at work? YES _____ NO______
NOTE: Applicant must be 18 years of age or older. Language(s) spoken ________________________
How did you learn about Cochrane- Smooth Rock Falls VCARS?_________________________________________________________________________ ______________________________________________________________________________

 

BACKGROUND INFORMATION

Education (include highest grade completed, high school, college, universities, relevant courses or training)_________________________________________________________________________ ______________________________________________________________________________

Employment (present position, related work experience)_________________________________________________________________________ ______________________________________________________________________________

Previous Volunteer Experience (length of experience, skills learned, views of volunteer work)_________________________________________________________________________ ______________________________________________________________________________

Additional Community Involvement _________________________________________________________________________ ______________________________________________________________________________

Recreation/Hobbies _________________________________________________________________________ ______________________________________________________________________________ 

 AVAILABILITY

VCARS is a 24-hour, seven day a week, on call service.

When are you available to volunteer?

Day shift: 8:00 am. to 4:00 pm. _____     Over night: 4:00 pm. to 8:00 am.  _____

Weekend: Friday 4:00 pm. to Monday 8:00 am. These shifts can be flexible. _____

How many days (shifts) can you do in a month ______ (at least 2 shifts per month required)

How long of a commitment could you realistically make to this service?___________(VCARS recommends at least 12 months.)

Why would you like to volunteer for Cochrane - Smooth Rock Falls VCARS?

_________________________________________________________________________

_________________________________________________________________________

REFERENCES : Known to you for at least 1 year.

(Example: employers, co-workers, friends, etc.) No family please and at least 1 past/present employer.

Name:_______________________________ Relationship:__________________________

Telephone (home):_____________________ Telephone (work):_____________________

Street Address:________________________ City, Province:________________________

Postal Code:__________________________

Name:_______________________________ Relationship:__________________________

Telephone (home):_____________________ Telephone (work):_____________________

Street Address:________________________ City, Province:________________________

Postal Code:__________________________

Name:_______________________________ Relationship:__________________________

Telephone (home):_____________________ Telephone (work):_____________________

Street Address:________________________ City, Province:________________________

Postal Code:__________________________

As part of the volunteer screening process you will have to consent to a background check, including a criminal record check with the OPP. Upon receipt of your application, we will contact you to make interview arrangement.

Applicant’s Signature: ___________________________________

Date: __________________________

Please print off and mail to:

Cochrane Smooth Rock Falls VCARS

144B 4th Street West  Box 2592

Cochrane ON P0L 1C0

or Copy it into a word document and e-mail it to: csrvcars@puc.net