Citizen Advocacy(CA) Volunteer Application

VOLUNTEER APPLICATION

(All information in this application will be regarded as strictly confidential)

• = required field

Date	M D: Y:
Name•
Address•
City•		Postal Code•
Phone•

Mailing Address	(If differnt from above)
City		Postal Code

Date of Birth	M D: Y:

Email•

Occupation			Employer

If a student	Year Area of Study:

Education	(Please indicate highest level obtained)

Degree/ Diploma

Other	(Please indicate skills training, specialized training i.e. first aid):

	Do you expect to change residence within the next year?
	Yes No
	If Yes, please indicate new location:

Languages	English French Other (Specify)

Please list other volunteer work:

	Could you give a year or more to the program? Yes No

	How did you find out about the programs at Citizen Advocacy?
	Newspaper Pamphlet Friend T.V. Radio Agency/Organization Other (Specify)

	Why do you wish to volunteer for Citizen Advocacy (CA)?


	In what capacity would you like to volunteer for Citizen Advocacy (CA)?
	Advocate Special Events Volunteer Committee Member Bingo Worker Office Volunteer Short-Term Advocate Companion Animal Visitation Program

	What do you hope to get out of this experience?


Are you available:	Days Evenings Weekends Flexible

Refernces:	Please list the names and addresses of three people whom we could contact (other than family members)
Name
Mailing Address		Postal Code
Phone
Relationship


Name
Mailing Address		Postal Code
Phone
Relationship


Name
Mailing Address		Postal Code
Phone
Relationship