Cochrane-Smooth Rock Falls VCARS Victim Services


                                                               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 convenient to contact you at work? YES _____ NO______
 

NOTE: Applicant must be 18 years of age or older.

Languages 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)_________________________________________________________________________
______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Personal information is collected under the authority of the Freedom if Information and Protection of Privacy
legislation to comply with Ministry insurance liability requirements. Personal information will remain confidential
unless prior consent to disclose is obtained. For more information contact the VCARS office.




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