Volunteer Form

Name:

Address:

Postal Code:

Telephone: (home)

Telephone: (cell)

Email:

Can you be contacted at your place of employment?

In Case of Emergency:

Contact Person:

Phone Number:

BACKGROUND INFORMATION:

EMPLOYMENT HISTORY: (If Applicable)

Name and Address of present or last employer:

Duties / Responsibilities

Skills obtained from previous employment:

Education:

Last completed:

Related Courses / Workshops:

MEMBERSHIPS:

Organization and Length of time as a member:

VOLUNTEER EXPERIENCE:

Organization and Volunteer Duties:

HOBBIES, INTERESTS, SKILLS:

AVAILABILITY:

Hours / Week:

Mornings:

Afternoons:

Evenings:

Weekends:

Other:

To help us plan the content for a volunteer orientation, we ask that you answer the following questions so that we have some understanding of your present knowledge of the issues of woman abuse. Please feel free to add issues you would like to have more information about. The questions we have chosen are those we are often asked during community presentations.

1. Why do women stay with or go back to an abusive partner?

2. What are some of the forms wife abuse takes?

3. Do you think women sometimes provoke or deserve abuse?

4. Other issues you would like information about.

Briefly explain your reasons for wanting to become involved as a volunteer with Haldimand-Norfolk Women's Services.

Have you received any services from Haldimand-Norfolk Women's Services in the past year?

If yes, please explain:

To be a volunteer with Haldimand-Norfolk Women's Services, I understand that I must supply two (2) references (other than family), sign an Oath of Confidentiality and pass a police security check. In order to comply with the Freedom of Information Act, it is the responsibility of the volunteer to provide the required police check. The necessary forms will be provided at your interview orientation.

REFERENCES:

Name and Address: (including postal code)

Reference 1

Reference 2

Enquiry:

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Your Registration Will Be Sent Via Email To The HNWS