Volunteer Application

Personal Information

Name

First Last

Address

Street Address Address Line 2 City ZIP / Postal Code

Phone - Residential

Phone - Cell

Phone - Business

Email*

Preferred Method of Contact

Skills, Interests and Talents

Please list your education background, including the years of attendance.

Please list your current or most recent occupation.

Please list your current hobbies, skills, interests.

Preferences in Volunteering

The Chatham Kent Women’s Centre has multiple roles for our volunteers. You many volunteer in more than one area. Which volunteer role(s) are you are interested in?

Are you over the age of 18?

Yes
No

Availability

What date are you available to start volunteering?

What times are you interested in volunteering? Please select all that apply.

We sometimes like to schedule volunteers for monthly, weekly, bi weekly shifts. Is this something you would be interested in?

Yes
No

If yes, for what duration?

Weekly
Bi-Weekly
Monthly

If yes, how many scheduled hours would you like to be scheduled for at a time?

One
Two
Three
More than Three

Do you have access to a vehicle you can utilize for volunteer work?

Yes
No

General Information

How did you hear about the Chatham Kent Women’s Centre?

Have you volunteered with Chatham Kent Women’s Centre in the past?

Yes
No

If yes, please briefly indicate in what capacity you volunteered and who you reported to:

Why are you interested in volunteering at the Women’s Centre?

Do you volunteer elsewhere in the community?

What personal goal(s) are you hoping to obtain through volunteering? (Example: add dimension to professional experience; socialization, etc.)

Confidentiality is something that our volunteers at Chatham Kent Women’s Centre have to adhere to in order to protect our clients. Are you willing to sign a letter of confidentiality stating that all matters relating to the CKWC will be held in the strictest confidence?

Yes
No

Are you willing to renew your confidentiality statement on a yearly basis?

Yes
No

References

Please provide the Women’s Centre with three references that our volunteer coordinator can contact. Please note that family members are not eligible to provide references. Suggested References; employer, professor/teacher, doctor, lawyer, pastor etc.

Name, Title, Relationship to you, Contact Information required.

In recognition of the trust inherent in serving children and vulnerable adults and to fulfill the requirements of the Chatham Kent Women’s Centre, a Police Clearance with the Vulnerable Sector Check no older than 6 months will be required prior to the acceptance of an individual as a volunteer of the Chatham Kent Women’s Centre. You will be required to renew the Police Clearance with the Vulnerable Sector check every 3 years. Do you agree to provide a Police Clearance with the Vulnerable Sector Check and have the same check completed every 3 years?

Yes
No

The Chatham Kent Women’s Centre respects your privacy and adheres to all legislative requirements with respect to protecting privacy. Your personal information will be used for the volunteer application process and related program purposes such as notification about recognition events. From time to time, Chatham Kent Women’s Centre may contact you about upcoming programs, special events and fundraising opportunities.

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