ESC VOLUNTEER APPLICATION

ESC VOLUNTEER APPLICATION

The information provided on this form will assist us in placing you in the most appropriate position. All information is kept confidential and is for office use only.
Application Date:

Month Day Year
Full Name:
Suite / Unit / Apt:
Street Address:
City:
Postal Code:
Date of Birth:

Day Month Year
Home Phone:

Area Code Phone Number
Cell:

Area Code Phone Number
E mail:
Transportation

Car Bus Walk DATS
Will you require parking?

Yes No
Do you have any special needs of which we should be aware of?

Yes No
If yes, please specify:
Emergency Contact Name:
Emergency Contact Phone:
Relationship:

Shift Availability:

Monday

Tuesday

Wednesday

Friday

Preference:

Morning Afternoon Regular shifts Occasional shifts
Allergies:
Comments / Skills / Interests:
Volunteer opportunities during COVID closures due to safety concerns:

Friendly Phone Calls Advertising / Sales Entertainment Online Instructor
If "Online Instructor", please specify:
Volunteer's Signature: *

Clear
Date

Month Day Year
You will be asked to go through training, abide by our code of conduct and our confidentiality agreement. Depending on the volunteer position, you might be asked to provide ESC with a Vulnerable Sector check from the Edmonton Police Department.
Should be Empty:

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