VOLUNTEER APPLICATION FORM

Date of Application:
We ask for your cooperation in responding to the following questions. The information you voluntarily
disclose will assist us in providing you with meaningful volunteer opportunities.

Family Name: First Name:

Address:
City: Province: Postal Code:

Telephone: Home _______________________ Cell______________________ Contact first □

Work__________________________Extension_______________ Contact first□

Male □ Female □ Date of birth: ________________________________

Email:

Emergency contact name:_________________________Relationship:____________________________

Phone number: __________________________________

What do you do?

Student: ____________ Field of study __________________________________

Working: ____________ Occupation____________________________________

Looking for work: ____________ In what field? __________________________________

Retired: _____________ Occupation ____________________________________

Other ______________________________________________________________________________

What languages do you speak? Rate your language skills (0= none, 5= fluent)

English? 0 1 2 3 4 5

French? 0 1 2 3 4 5

Which is your preferred official language? _________________________________

Do you know any other languages? Rate your language skills (0=none, 5=fluent)

______________________________ 0 1 2 3 4 5

______________________________ 0 1 2 3 4 5

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Have you volunteered before?

Organization ______________________________Task (s) _____________________________________

Organization ______________________________Task(s) ______________________________________

What attracted you to volunteer with us?

_____________________________________________________________________________________

_____________________________________________________________________________________

How did you come to hear about us?

News/TV/Radio □ Website (CCI or Community Cup) □ Public speaker □ Poster □

Email □ Volunteer Centre □ CCI Staff or Volunteer □ Other □
Do you use any of the following social media?

Facebook □ Twitter □ YouTube □ Flickr □ Other □

What abilities, special skills or knowledge would you like to share with us as a volunteer?
_____________________________________________________________________________________

_____________________________________________________________________________________

When are you available to volunteer?

Days □ Evenings and Weekends □ Flexible □ Occasionally □

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References:

We work with a vulnerable client population. It is therefore necessary for all volunteers to provide us
with two references.

1. _______________________ ________________________________ _____________________

First name Last name Relationship

Tel # home ___________________ Work ______________________email address__________________

2. _______________________ ________________________________ _____________________

First name Last name Relationship

Tel # home ___________________ Work ______________________email address__________________

Acknowledgement and Understanding

To the best of my knowledge and belief, the information set out in this form is true and correct. I
acknowledge that the Catholic Centre for Immigrants is relying on the accuracy of the above information
to determine my suitability of volunteer opportunities within the Catholic Centre for Immigrants
I consent to the above-captioned reference checks and this form, if signed, that the Catholic Centre for
Immigrants full and sufficient authority for so doing. I authorize any person giving a reference to disclose
information that they may have regarding my character and or my application
I understand that all Catholic Centre for Immigrants volunteers must submit to a police records check
and hat volunteers do not begin their volunteer duties of tasks until the police records check is
processed. Consider this my undertaking to sigh the “Police Records Check for Service with the
Vulnerable Sector” form
I acknowledge that the association with Catholic Centre for Immigrants is voluntary and purposed and
that I am not authorized to act as a spokesperson for the agency unless authorized by the management
of the Catholic Centre for Immigrants to do so.
I understand that all documents, technical innovations and other works or creations produced by
volunteers are considered charitable contributions to the agency and are hear by assigned to the
Catholic Centre for Immigrants
I undertake to use the best efforts to fulfill my commitments to the Catholic Centre for Immigrants. I
undertake to be conscientious and to conduct myself with dignity, courtesy and consideration of others

Dated at Ottawa, this ___________________day of __________________________________ 20______

Signature of applicant _________________________________________________

Name and signature of parent or legal guardian (if applicant is under 18 years of age

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 Name

_______________________________________signature_________________________________

Publication and Email consent

The Catholic Centre for Immigrants creates promotional tools to promote its mission. To that end, do
you authorize CCI to take pictures or film footage in which you appear and to publish or broadcast them.
Please initial:
Yes No

From time to time, the Catholic Centre for Immigrants contacts its volunteers to inform them of events,
programs and other items of interest. To that end, do you authorize CCI to contact you through mail or
email? Please initial
Yes No

Volunteer records will remain confidential and will be kept in a secure location. Access to volunteer
records will be limited to staff. Information provided will only be used to determine suitability for
volunteer opportunities within CCI and for statistical purposes. Volunteers have the right to examine the
information in our possession that concerns them directly.

Date ____________________________Name: _______________________

Office use only: Interview by: References by:

PRC Completed: Received Date: by:

Proposed Role(s):

Comments: