CDVS Volunteer Application Form | Caledon Dufferin Victim Services

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CDVS Volunteer Application Form

Personal Information

Name

Address

City / Town

Province

Postal Code

Home Phone

Cell Phone

Languages

Please list the languages that you can SPEAK fluently

Please list the languages that you can WRITE fluently

CDVS Connection

How did you find out about CDVS?

If you learned about CDVS by some other means than those listed above, please tell us how:

If you were referred by a CDVS volunteer, please provide us with his/her name

Driving Record and Automobile Insurance

Please note: a valid driver's license and valid insurance are required for this position

Have you ever been charged with a criminal traffic offense?
Yes No

Have you ever been notified by the Ministry of Transportation that you have 6 or more demerit points?
Yes No

Do you possess valid automobile insurance?
Yes No

Have you ever been convicted of any criminal offense(s) for which a pardon has not been granted or issued?

This includes, but is not limited to: fines, imprisonment and court probation

Yes No

Education

Please indicate the highest level of education or credentials that you have achieved

Details of other courses, workshops, seminars or experiences that may be pertinent to your work as a volunteer with CDVS

Employment

Are you presently employed?
Yes No

Profession / vocation / job title

Employment status

Full time

Part time

Self employed

Retired

Other:

Volunteer Experience - Past and Present

Volunteer position, organization and time frame

What part of volunteering did/do you find personally rewarding?

References

First professional reference name

Organization

Relationship

Phone

E-mail

Second professional and/or personal reference name

Organization

Relationship

Phone

E-mail

We would like to acknowledge that the land on which we gather is the traditional territory of the Haudenosaunee, Iroquois, Ojibway/Chippewa, Anishinabek, the Metis, and most recently, the territory of the Mississaugas of the Credit River. This Territory is covered by the Upper Canada Treaties and the Haldimand Treaty. We are grateful to live and work on this land. The territory was the subject of the Dish With One Spoon Wampum Belt Covenant, an agreement between the Iroquois Confederacy and the Ojibwe and allied nations to peaceably share and care for the resources around the Great Lakes.

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905-951-3838

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905-951-3838
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1-888-742-2658

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