Victim Services Volunteer Application Form

Part A: Personal Information

Given Name

First Name

Last Name

Preferred Name

Preferred Pronouns

Our agency is committed to being reflective of the communities we serve. People from equity deserving groups are strongly encouraged to apply and self-identify. If you are comfortable identifying, please do so down below.

Address

Address Line 1

City

Province

Postal Code

Email Address

Home Phone

Cell Phone

What languages do you speak?

Are you at least 20 years old?

Have you received service from VSW in the last 12 months?

Please provide your G Class driver's license number (must have access to a reliable vehicle)

Why did you choose Victim Services Wellington to volunteer your time?

How did you hear about this volunteer opportunity?

If other, please specify

Part B: Background Information

Relevant Cources or Training

Employment

If employed, please specify

If other, please specify

Volunteer Experience: Are you currently volunteering? If yes, please list the organization(s) and describe your role.

Part A: References (Please include 3)

Reference Name

Phone Number

Relationship (other than family)

Reference Name

Phone Number

Relationship (other than family)

Reference Name

Phone Number

Relationship (other than family)

Part D: Acknowledgement

Due to the sensitive nature of this work, all volunteers are screened and interviewed. References will be contacted, and all volunteers must obtain a vulnerable sector check before beginning volunteer duties with Victim Services Wellington. Please note that any false information given on this application will prevent you from becoming a volunteer.

I certify that all the information provided is truthful and accurate. *

Yes