Volunteer Signup

Volunteer Application Form

First Name:*
Last Name:*
Address:
Apt#:
City:
Postal Code:

Home phone:
Business Phone:
Cell Phone:
Email Address:*
Volunteers under the age of 18 require written permission from a parent/guardian to volunteer. The appropriate Parental Consent Form can be picked up from the Etobicoke Services for Seniors office.
Are you at least 18 years of age?*
Have you ever been convicted of a criminal offence for which you have not been pardoned?*
(A Police Records Search is required for many of our volunteer positions).
How did you hear about Etobicoke Services for Seniors?
Why would you like to volunteer for Etobicoke Services for Seniors?
Please list any previous volunteer experience:
Hobbies and Interests:
Please list any additional training or programs you have completed:
Program/Training:		Date:		Description:
Program/Training:		Date:		Description:
Program/Training:		Date:		Description:
Please check the volunteer position(s) which interest you:
	Adult Day Services Assistant		Volunteer Visiting		Board of Directors
	Senior’s Lunch Program Assistant		Fundraising		Committee Member
	Escorted Transportation Driver		Office Support		Telephone Reassurance
	Caring Centre Visitor		Adult Day Services/Lunch Program Entertainer
Please indicate the day(s) and time(s) of day that you are available to volunteer: (i.e.: Monday 9AM-5PM, Friday 1PM-4PM, etc)
Available to volunteer:
What length of time are you able to commit to volunteering?
	Less than 3 months		3-6 months
	6-12 months		more than 1 year
Please provide the names of two individuals who can be contacted for a reference check. One may be a family member or friend, and the other must be a previous employer or volunteer manager.
Name:		Relationship:		Phone #: (day)
Name:		Relationship:		Phone #: (day)
Authorization for collection of personal information:
	I authorize Etobicoke Services for Seniors to complete a reference check with those individuals listed above












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