Print our volunteer application form - Canadian Red Cross

Canadian Red CrossCroix-Rouge canadienneVolunteer Application FormOur MissionThe Canadian Red Cross mission is toimprove the lives of vulnerable people bymobilizing the power of humanity in Canadaand around the world.Our Fundamental PrinciplesIn common with Red Cross and RedCrescent Societies around the world, theCanadian Red Cross is committed toupholding and advocating the principles of:Humanity ImpartialityNeutrality IndependenceVoluntary Service Unity UniversalityThank you for completing this form. Please print clearly.All information gathered will be kept confidential and will be used only by the Canadian Red Cross.GENERAL INFORMATIONLast Name: ______________________________ First Name: ___________________ Initial: ____________Address:________________________________________________ Apt/Unit#: ________________________City:_________________________ Province: ____________________ Postal Code: ____________________Home Telephone: _________________________ Business Telephone: _______________________________May we call you at work? Yes No Fax:_________________ E-mail: _________________________Cell Phone/Pager:_________________________ Emergency Contact Name: __________________________Home phone: __________________ Business phone: _________________Cell phone: ___________________2 nd Emergency Contact Name: ______________________ Home phone: _____________________________Business phone: _________________Cell phone: ___________________Valid Driver’s License: Yes No If Yes, Class: ______Licence #::___________________________APPLICANT PROFILE QUESTIONSRed Cross adheres to and complies with the provisions under the provincial and territorialHuman Rights Acts.Have you ever been employed by, or volunteered with, the Red Cross?If yes, please specify where, when, and your position or role. Yes NoVolunteer Application Form - National FormEffective Date: January 1, 2001Date of Last Revision: March 13, 2006Page 1 of 5

Are you currently employed? Yes NoPosition/Title:Employer:Employer Address:Can you provide a resume? Yes Attached NoIf not, please provide a list of your work experience:SETWhat special skills, training or qualifications do you have that you would like to use in your volunteer role (e.g.,accounting, public speaking)?Which computer software programs do you have experience working with?Language:________________________ Speak Read Write_______________________ Speak Read Write________________________ Speak Read WriteRed Cross may give my name and address to other agencies or businesses with which it is partnered oraffiliated that may wish to offer Red Cross volunteers discounts or group rates on goods and/or services. Yes NoREFERENCES1. Present or former employer/volunteer agency; 2. Educational institution; 3. Acquaintancebelonging to a recognized profession who has known you for at least 2 years such as yourdoctor, lawyer, or an eligible guarantor of a passport application (to be used if #1 and #2 are notan option).Name:Address:Telephone Number:Relationship to Applicant:____________________________________________________________________________________________Name:Address:Telephone Number:Relationship to Applicant:___________________________________________________________________________________________Name:Address:Volunteer Application Form - National FormEffective Date: January 1, 2001Date of Last Revision: March 13, 2006Page 3 of 5

Telephone Number:Relationship to Applicant:_________________________________________________________________________________________I certify that the information in this application is correct and complete. I agree to behave in accordance withthe Fundamental Principles of the Red Cross. I give my permission to the Canadian Red Cross to contact theabove references and to obtain, if required, a criminal record check and/or a driver’s abstract. I understand thatI will be advised in advance if a criminal record check and/or a driver’s abstract is required. I understand that ifI am below the age of majority I must have my parent/guardian sign and provide their contact informationbelow.______________________________________________________ _________________________Signature of applicantDateI am aware and support __________________________’s decision to volunteer with the Canadian Red Cross.Name____________________________________Telephone: ______________________________Address_____________________________________________________________________________________________________________________________Signature of parent/guardian of applicant below age of majority_______________________________DateFOR OFFICE USE ONLYInterviewed by: ___________________________________ Interview date: _________________________ Volunteer Applicant Interview Guideline completed and in General File Volunteer Applicant Interview Rating completed and in General File Volunteer Applicant Reference Check #1 completed and in Restricted File Volunteer Applicant Reference Check #2 completed and in Restricted File Volunteer Applicant Reference Check #3 completed and in Restricted File Criminal Record Check obtained and in Restricted File (applicable, not applicable) Driver’s Licence photocopied and in General File (applicable, not applicable) Driver’s Abstract obtained and in General File (applicable, not applicable)Accepted: Yes No If not, why?Placement: _____________________________ Supervisor:___________________________________ Position Description shared and in General File Volunteer Agreement signed and in General File Resume received and in General FileDate available to begin: _______________________________________Start date: __________________________________________________Orientation date: _____________________________________________Volunteer Application Form - National FormEffective Date: January 1, 2001Date of Last Revision: September 2006Page 4 of 5

Data input date: ______________________________________________ Initials: ________Date of resignation: ___________________________________________ Volunteer Exit Interview completed and form in General File - Interview date:______________________General Observations/Comments/Notes:Volunteer Application Form - National FormEffective Date: January 1, 2001Date of Last Revision: March 13, 2006Page 5 of 5