Embed Size (px)
Citation preview
VOLUNTEER APPLICATIONFORM
128 St. Vincent Street Barrie, ON L4M 3Y8 Tel: 705-726-9778 Fax:705-722-5082 [email protected] with the CanadaRevenueAgency
RegistrationNo. 128793049RR0001
INTERN APPLICATIONJOBINFORMATIONPosition Location
Date Received:
Date
Interviewed:
Start Date:
Mission Internship
Camp Promise128 St. Vincent Street Barrie ON L4M 3Y8Contact: Tracy RobinsonCell: 705-726-9778Email: [email protected]
PERSONALINFORMATION
Last Name First Name M.I
StreetAddress Apart/Unit City PostalCode
HomePhone CellPhone Email
Health Card # Date ofbirth Church name (ifapplicable)
CurrentSchool/Workplace Gradelevel
EMPLOYMENT/VOLUNTEERHISTORY
Date Employer/Supervisor Jobtitle/Volunteer position
REFERENCES
FullName Relationship Phone Email
AVAILABLITY
What age group would you like to workwith?
Children (ages 5-10)
Youth (ages 11-14)
September 1, 2018 to August 1, 2019
September 1 , 2018 to December 24, 2018
January 1 2019 to July 31 2019
May 15, 2019 to August 15, 2019
VOLUNTEER APPLICATIONFORM
INTERN APPLICATION
128 St. Vincent Street Barrie, ON L4M 3Y8 Tel: 705-726-9778 Fax:705-722-5082 [email protected] with the CanadaRevenueAgency
RegistrationNo. 128793049RR0001
ADDITIONALINFORMATIONPlease check all experience/qualifications youpossess:
Please provide a brief narrative of your spiritual life story (ifapplicable):
Describe any experience you have in working with ateam?
Describe your strengths/skills/talents that are applicable to working with children and youth?
Describe anyweaknesses?
Describe briefly what you know about working with children/youth at risk?
Child/youthwork Christianministry Leadership Planning Workingwithnon-profitorganizations Artsandcrafts
Communitydevelopment FirstAid/CPR Social Work Camp/clubexperience Musical abilities Sports OTHER
VOLUNTEER APPLICATIONFORM
INTERN APPLICATION
128 St. Vincent Street Barrie, ON L4M 3Y8 Tel: 705-726-9778 Fax:705-722-5082 [email protected] with the CanadaRevenueAgency
RegistrationNo. 128793049RR0001
MEDICAL /HEALTHAtCamp Promise,providingasafeenvironmentforourchildrenandyouthisparamount.Assuch,weendeavourtobeasforthcomingas possiblewiththestressesapersoncanexpecttoexperienceinourenvironment.WealsoaskthatapplicantsareupfrontwithCamp Promiseaboutpastorcurrentstrugglesand/ormedicalconditions.Pleasebeawarethat,insomecircumstances,furtherdocumentationmayberequired.Anythingnotdisclosedthat may affect the safety of teammates or children canbegroundsfor removal from the volunteer position.
Informationprovidedinthefollowingsectioniskeptinstrictconfidence.
Do you have a history or past incidentsof:
a. Emotionaldifficulties
b. Medical/physicalconditions
Please check off any of the following conditions or experiences that have occurred or that you suspect may be true for you (even if it has not beenmedically diagnosed)
Condition/experience YES NO If yes please provide moreinformation
Depression
Eating Disorder (e.g Anorexia,Bulimia etc)
Anxiety
ChronicFatigue
Allergies
ADD/ADHD
ODD
Self Injury (e.gCutting)
AngerManagement
Abuse: Physical, Emotional,SexualAre you currently on any medication YES/NO (Please list with reason foruse)
Icertifythatallanswersprovided inthisformandduringthe interviewaretrueandcomplete.Iunderstandthatprovidingfalseormisleadinginformation,ortheomittingofinformation,maybegroundsforrejectingmyapplicationor,ifhired,mayresultindismissal.
Signature: Date:
