Volunteer - Momentum Walk In Counselling

Name:*

Email*

Home Phone: *

Work Phone: *

Cell Phone: *

Address: *

Address 2:

City: *

Province: *

Postal Code: *

How did you learn about our volunteer opportunities? *

Have you volunteered with our agency before? *

If so, in what capacity?

Languages spoken other than English?

Upload Resume that includes education, employment and volunteer history (PDF or Word Docs)

Emergency Contact Name: *

Cell Phone:

Relationship: *

Day Phone: *

Evening Phone: *

Are you accustomed to working with team feedback? *

I am willing to sign a contract, upon completion of the agency's training, which will outline the terms and conditions of my volunteer work at the Momentum: *

I am willing to volunteer at Momentum for one year, after being accepted: *

I am willing to submit to a security clearance and a child welfare check: *

Reference 1 Name: *

Email: *

Relationship: *

Day Phone: *

Work Phone: *

How Many Years

Reference 2 Name: *

Email: *

Relationship: *

Day Phone: *

Work Phone: *

How Many Years: *

Please ensure you notify your references in advance of our call. Please provide the names of two employment, education or volunteer-related references (not family members or friends)

The above information is true and accurate

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