Volunteer Application Form NEW

Participant Information

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City Province Postal Code

Email(Required)

Phone(Required)

EXPERIENCE & INTERESTS

ORGANIZATION(Required)

LENGTH OF TIME AS VOLUNTEER/EMPLOYEE(Required)

POSITION(S) HELD & MAJOR RESPONSIBILITIES(Required)

ORGANIZATION

LENGTH OF TIME AS VOLUNTEER/EMPLOYEE

POSITION(S) HELD & MAJOR RESPONSIBILITIES

ORGANIZATION

LENGTH OF TIME AS VOLUNTEER/EMPLOYEE

POSITION(S) HELD & MAJOR RESPONSIBILITIES

Please indicate if you are currently:(Required)

Please tell us your age group range:(Required)

Youth under 18

Youth 18 - 24

Adult over 24

Senior 60+

Date of Birth (dd/mm/yyyy)(Required)

Languages you are fluent in speaking:(Required)

Languages you are fluent in reading:(Required)

Languages you are fluent in writing:(Required)

Please tell us why you are interested in volunteering with us: (check all which apply)(Required)

If Other, add more details

Please indicate which of the following volunteer positions interest you: (check all which apply)(Required)

If Other, add more details

Please indicate your availability (week days):(Required)

Please indicate your availability (time):(Required)

Mornings 9am-12pm

Afternoons 12pm-4:30pm

Evenings after 4:30pm

Please indicate your location preference (check all which apply):(Required)

Burlington

Milton

Oakville

Whats your school name?

REFERENCES

Please provide us with two non-family references (teacher, coach, employer, past volunteer organizations or professional references) that we may contact to verify information regarding your application.

REFERENCE 1

Name(Required)

First Last

Relationship to Participant(Required)

Phone(Required)

Email(Required)

REFERENCE 2

Name

First Last

Relationship to Participant

Phone

EMERGENCY CONTACT

Emergency Contact Name(Required)

First Last

Emergency Contact Phone Number(Required)

Relationship to Participant(Required)

APPLICANT SIGNATURE(Required)

By signing below, I hereby certify that the information included within this application is true and complete. Additionally, I authorize the HMC Connections (HMC) to verify the references I have supplied. I understand that the information obtained will be confidential but may be shared with relevant HMC departments. I acknowledge and understand that if I am successful in obtaining a volunteer position with HMC, the volunteer position is conditional upon receipt of an original Security Clearance Request (Volunteer)** and Vulnerable Sector Screening that is acceptable to HMC.

Parent/Guardian Signature (for volunteers under the age of 18)

I support this volunteer activity & give my permission for my child to apply to participate as a volunteer with the HMC Connections.

ACKNOWLEDGEMENT OF CONFIDENTIALITY, DUTIES AND OBLIGATIONS

TO: HMC Connections I, as volunteer or paid staff member with the HMC Connections (“HMC”) hereby acknowledge that it is my duty and obligation to do the following: (i) I understand and agree to uphold the principle that HMC has an ongoing and continuing duty to protect the confidentiality and privacy of its past and current clients; (ii) That all clients files, memos, notes, documents and related property in the course of my involvement with HMC are the sole property of HMC and shall remain the property of HMC, during and after conclusion of my involvement with HMC, now and forever; (iii) That I shall ensure the safeguarding and keeping of all client files, memos, notes, documents and related property at HMC premises; (iv) That I shall never remove, copy or duplicate or cause to be copied or duplicated or remove any clients files, memos, notes, documents and related property from HMC premises, except in the normal course of executing my proper duties on behalf of HMC or with the express permission of an HMC; (v) That I shall immediately return all client files, memos, notes, documents and related property to HMC premises upon conclusion or termination of my involvement with HMC; and, (vi) That I shall not use my capacity as volunteer or paid staff member with HMC to personally profit from the serving of HMC clients, such as payments or gifts in kind from third parties (i.e. Lawyers) for referrals or assistance of any kind, in relation or stemming from my involvement with HMC, without the express written permission of HMC. I understand that this obligation and duty requires me to report and deliver all honorariums to HMC to be credited to the HMC general fund. I HAVE FULLY READ AND UNDERSTAND THIS ACKNOWLEDGEMENT AND AGREE TO BE BOUND BY ALL OF THE DUTIES AND OBLIGATIONS SET OUT ABOVE AND I HEREBY SIGN THIS ACKNOWLEDGEMENT AS A CONDITION OF MY VOLUNTEERISM. Protecting Your Privacy HMC Connections respects and is committed to protecting your personal information. The information you provide to us is used to provide an appropriate position suitable for you and your interests. Once you are a volunteer at HMC, we use your information to: provide you with information about HMC, track your volunteer efforts in the organization, acknowledge and recognize your volunteer efforts, improve our volunteer management program at HMC, and keep in contact with you after you have finished volunteering. The HMC connections, the Freedom of Information and Protection of Privacy Act (Ontario), and the Personal Information Protection Act (Ontario), protects your information. If you have any questions regarding the release/ use of your personal information, please contact the Community Connections Coordinator at the HMC Connections.

Date(Required)

Witness Signature:(Required)

Volunteer Signature:(Required)

Media/Electronic/Print/Publications/Communications Release Form

Group/Participant Name: Release Form

I, the above named volunteer, student, employee, group, participant at the Halton Multicultural Council, unequivocally consent to the publication, release and transmission of the digital/electronic/print/photographs, to the extent that they may deemed necessary for express use thereof. The release is binding beyond the following engagement term as it is time sensitive in its creation and release: Employment Volunteer Undertaking Student Graduation Casual Assistance Person Contract Position This release and consent is voluntary. If you don’t wish to participate, there is no obligation on your part.

I agree: (please check)(Required)

Yes

Signature(Required)

Date(Required)

Incomplete and/or unsigned applications will not be considered. A current resume needs to be included along with this application. www.hmcconnections.com 1092 SPEERS ROAD, OAKVILLE, L6L 2X4, TEL: 905 842 2486, FAX: 905 842 8807 For volunteer inquiries please contact: Norma Prado at 905 842 2486 ext. 240 or community.connections@nullhmcconnections.com