download the volunteer application form by housework

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More Info
									                                                                    For Office Use Only:

                                                                    Interviewed by: _____________

                      4845 Imperial St., Burnaby, BC V5J 1C5        Security Check Result: ________
                      Tel: 604-431-0400, Fax: 604 431-9499          Date: _____________
                      Email: sbnh@vcn.bc.ca
                                                                    Reference Check: ___________

                                                                    Placement: _________________
Youth Volunteer                                                     Comments: _________________

Application Form

First Name_______________ Last Name ____________________Sex _____
Address_____________________________                   City _____________
Postal code___________Phone #________________Cell #_________________
E-mail address_______________________________________________

Emergency Contact:
Name_______________________________                    Phone #____________________
Family Doctor_________________________ Phone #____________________
Education
School:____________                    Grade:________
Languages you are fluent in:
Speak______________ ______________ ____________ _____________
Read/write___________ _____________ ____________ ______________
References (an adult who is not your relative)
Name_______________________________                    Phone # __________________
Relationship (friend, family friend, neighbour, school counselor, etc.)
_____________________________
Past or present volunteer service _____________________________________
______________________________________________________________________________________
Interests, Hobbies, Skills ___________________________________________________________
______________________________________________________________________________
Type of activities/programs you are interested in __________________________
________________________________________________________________
Available which days & times _________________________________________
________________________________________________________________


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Why would you like to volunteer with the SBNH? ___________________________________
________________________________________________________________
Do you have any health problems (allergies, diabetes, etc.) or restrictions which
might require attention/observation? If so, please specify
________________________________________________________________
Do you have any special certification (first aid, class 4, etc) that will be useful to
your position? If so what is it and when does it expire?
________________________________________________________________




YOUTH APPLICANTS: PLEASE HAVE YOUR PARENT/ GUARDIAN SIGN
BELOW


I,________________________________, grant permission for my son/daughter
                  (please print name)
named above to volunteer with the South Burnaby Neighourhood House, and
0agree to assume all financial responsibility in case of injury or accident in
connection with his/her volunteer assignments.

Signature___________________________                           Date_______________________
------------------------------------------------------------------------------------------------------------
   For Office Use Only:
  Reference:




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