Volunteer Application - Campbell River Beacon Club

Name *

First

Last

Email Address *

Home Phone Number *

Cell Phone Number *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

What would you be interested in volunteering with the Beacon Club? *

Availability *

Emergency Contact Information

Name *

First

Last

Relationship with Volunteer: *

Home Phone *

Cell Phone *

Email *

About you

Special training, skills, hobbies: *

Why are you interested in volunteering with this mental health program? *

Do you have any medical and/or physical conditions that may impact your volunteering with the Beacon Club? *

No
Yes

Please explain

Do you have any allergies or special considerations? *

No
Yes

Please explain

Do you foresee any changes in your availability in the near future? *

No
Yes

Please explain

Have you ever been convicted of a crime? *

No
Yes

Please explain the nature of the crime and the date of the conviction and disposition.

Conviction of a crime is not an automatic disqualification for volunteer work with the Beacon Club.

Do you have a current Driver’s Licence? *

Yes
No

Do you have a Class 4 unrestricted or Class 2 Driver’s Licence? (please attach if applying to drive) *

Yes
No

Class 4 unrestricted or Class 2 Driver’s Licence

Drag & Drop Files, Choose Files to Upload

Do you have a current Food Safe Certification? *

Yes
No

Do you have a Special Event Server Certification? *

Yes
No

Do you have a Serve it Right Certification? *

Yes
No

Do you have a current Emergency First Aid or higher? *

Yes
No

References

Please list 3 people who know you well and can attest to your character, skills, and dependability. Include your current or last employer.

Name / Organization (Reference One) *

First

Last

Relationship to You (Reference One) *

Phone (Reference One) *

Length of Relationship (Reference One) *

Name / Organization (Reference Two) *

First

Last

Relationship to You (Reference Two) *

Phone (Reference Two) *

Length of Relationship (Reference Two) *

Name / Organization (Reference Three) *

First

Last

Relationship to You (Reference Three) *

Phone (Reference Three) *

Length of Relationship (Reference Three) *

Privacy Practice Statement

We protect your personal information and adhere to all legislative requirements with respect to privacy. We do no rent, sell or trade or lists of volunteers. We use your personal information to keep informed and up to date activities of the organization and its specific programs including, but not limited to; opportunities to volunteer, upcoming events, educational opportunities, and seasonal greeting.

Required information to be obtained; when it is applicable to the job description being performed by the volunteer.

Criminal Record Check

Yes
N/A

Drivers Abstract

Yes
N/A

Driver’s License Class

Yes
N/A

First Aid Certification Level

Yes
N/A

Food Safe Expiry

Yes
N/A