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    Identification:

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    * First Name:
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    Middle Inital
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    * Last Name:
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    Do you have a driver's License? Yes
    No
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    Are you 19 Years or older? Yes
    No
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    Address and Contact Information:

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    Street Number:
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    Apt #:
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    * City:
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    Postal Code:
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    * Home Phone:
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    E-Mail
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    Employment Information:

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    Are you currently employed? Yes
    No
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    May we call you at work? Yes
    No
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    Work phone number?
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    Skills and Experience:

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    Please list any languages you speak in addition to English (if applicable):
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    * How did you hear about us?:
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    Have you done volunteer work before? Yes
    No
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    If yes, please list the organizations(s) and describe your role:
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    * Explain what you feel you can bring or add to our team:
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    Requirements:

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    * Are you able to complete a minimum of two(2) "On-Call" shifts per month? Yes
    No
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    * Are you willing to make a one-year commitment to the program? Yes
    No
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    * Are you able to complete the required training? (40 hours scheduled on weekends) Yes
    No
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    * Have you ever been charged with and/or convicted of a criminal offence for which a pardon has not been granted? Yes
    No
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    References:

    Please provide one personal and one professional, education or volunteer reference.
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    * Reference #1 Name:
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    * Reference #1 Phone:
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    * Reference #1 Realationship:
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    * Reference #2 Name:
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    * Reference #2 Phone:
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    * Reference #2 Realationship
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    * Reference #3 Name:
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    * Reference #3 Phone
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    * Reference #3 Realationship
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    * By checking this box, I certify that all the information provided above is truthful and accurate: NOTE: Due to the sensitive nature of this work, all volunteers are screened and interviewed. References are thoroughly researched and a police security check must be done before you can work for Parkland Victim Services Program. Please note that any false information given on this application will prevent you from becoming a volunteer. If there are any changes to the information you provided, please notify Parkland Victim Services immediately.
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