FAMILY SERVICES OF CENTRAL ALBERTA
VOLUNTEER FORM
5409 - 50th Avenue
Red Deer, AB T4N 4B7
Phone: 403-343-6400 Fax: 403-343-6407
E-mail:
fsca@fsca.ca
FSCA General Volunteer:
Other Special Events:
Have you volunteered with FSCA before?
Yes
No
CONTACT INFORMATION
Age of Volunteer:
under 13
13-16
16-18
18-55
55+
(
NOTE
: A
Parent/Guardian Consent Form
is required if applicant is under 18 years of age
)
First Name:
(* required)
Last Name:
(* required)
Street Address:
City:
Province:
Postal Code:
Daytime Phone:
(* required)
Business/Cell Phone:
Fax Number:
E-mail Address:
(* required)
I prefer to be contacted by:
Phone
Business/Cell Phone
Fax
Email
EDUCATION and EMPLOYMENT HISTORY
Highest level of education completed:
High School
College
University
Trade/Business
Other
Current Occupation:
Please provide your employment history - including company name, dates worked, brief description of responsibilities:
SKILLS & EXPERIENCE
Have you received
training or experience
in any of the following areas:
Child Care
Clerical Skills
Computer Skills
CPR
Event Planning
Experience with Older Adults
Experience with Children
First Aid
Food Services
Fundraising
Marketing
Music Ability
Organizational Skills
Public Speaking
Security
Second Language
Any other training:
VOLUNTEER HISTORY
How often can you commit to volunteer?
Weekly
Monthly
Special Events Only
Please indicate the
days and times
you are available to volunteer:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Morning
Afternoon
Evening
Which volunteer activities interest you?
Child Care/Children
Clerical Activities
Fundraising
Physical work/cleaning
Parenting Groups
Older Adults
Special Events
If other, please specify:
What is your main reason for volunteering?
Academic credit
Learn new skills
Social interaction
Employment experience
Help others
If other, please specify:
Any physical limitations, medical conditions or allergies that may affect you volunteering:
Are you currently volunteering elsewhere?
Yes
No If yes, where?
Please provide your volunteer history - including organization, dates worked, brief description of responsibilities:
EMERGENCY CONTACT INFORMATION
Name:
Address:
Phone Number:
Relationship:
REFERENCES:
Name:
Name:
Address:
Address:
Phone Number:
Phone Number:
Relationship:
Relationship:
OTHER INFORMATION
How did you find out about our volunteer program?
Friend/Relative
Internet/Website
Newspaper
Poster/Brochure
School
Visit to FSCA
Declaration:
I hereby declare that the above information is true and complete to the best of my knowledge. I understand that a false statement may disqualify me from further consideration as a volunteer or result in dismissal.
Authorization for collection of personal information:
I authorized Family Services of Central Alberta to collect personal information appropriate to the opportunities applied for concerning my academic background and employment history, and to verify the character references I have supplied. Family Services of Central Alberta adheres to the
Protection of Privacy Act
and the
Freedom of Information and Protection of Privacy Act
.
I understand that:
A
Police Record Search
is required for potential volunteers who are applying for positions that are considered to have, or potentially have, interaction or contact with children, youth and other vulnerable groups. Volunteer placement is made on the basis of the program requirements, the skills, and experience of the applicant and, when appropriate, successful reference checks and a police record search.
Signature:
Date:
Enter the
Validation Code
to proceed (then click "submit"):
