VOLUNTEER APPLICATION FORM
Please fill out this application and submit.
Email *
What type of volunteer positions are you interested in?
Driver for appointments only
Driver for grocery pick up only
Driver for both groceries and appointments
Yardwork summer only
Snow removal
Deliver Newsletters and flyers
Events and fundraising
Pen Pal
Daily hello phone calls
Administrative
Board Member
Check all you are interested in
Name: *
Address: *
Postal Code: *
Phone Number: *
Cell/Alternate Number:
Best time to contact you? *
Important Health Disclosure Information
In order to maintain the safety of our seniors and volunteer drivers, we would need to know any medical or physical limitations that may determine who we would match you with for transportation needs.
Do you have any medical/physical limitations? If so, please list. It is your responsibility to disclose any medical or physical limitations that may affect your ability to drive and or lift. Your Health and safety is important to us.
Personal History
In order to maintain the safety of our seniors and volunteer drivers, we would need you to obtain a Criminal Record Check and Adult Abuse Registry Check. We also need a Drivers Abstract and will need to provide us a photo for identification reasons.
To ensure the safety of our seniors as well as our drivers, we require a criminal record check and an adult abuse registry check in order to directly work with our seniors. We will reimburse these costs if we have at least a 3-month commitment. Do you have a check that has been done within the last 6 months? *
Required
Are you willing to allow us to take your photo to be used for a very basic profile sheet for our seniors to identify you when picking them up? *
Drivers License and Driving Record information
In order to maintain the safety of our seniors, we would need you to obtain a Drivers Abstract and list the type of vehicle you would be using to transport our seniors. This is also to help the senior you are assigned to can know what type of vehicle you are driving.
We will require a most recent driver's abstract from Manitoba. Are you willing to obtain this? *
Have you recently been involved in a motor vehicle accident? *
If yes, please explain the circumstances:
Make and model of the vehicle you will be using: *
Drivers License Number
Experience
Tell us about your experience working with seniors?
Do you have experience working with seniors? *
If yes, please list any relevant experience you have had: *
Have you volunteered with any organization before? *
If yes, please share the experience you have had: *
What are your reasons you are wanting to volunteer with Broadway Seniors Resource Council? *
How did you hear about Broadway Seniors Resource Council? *
What day(s) of the week are you are available? *
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Click on days available
What hours work best for you? *
Mornings, 8:00 am-12:00 pm
Afternoons, 12:00 pm-4:00 pm
Evenings, 4:00 pm-8:00 pm
Click times available
How long do you wish to commit to driving for us? *
References
Please list 3 references with their contact information and the nature of your relationship.
Reference 1: *
Reference 2:
Reference 3:
Privacy
All information is strictly confidential and is only used for its intended purposes by the BSRC.
Do you hereby acknowledge that all information you provided is truthful and give consent to Broadway Seniors Resource Council to use this information as part of its volunteer recruitment procedure. *
Signature of Applicant *Typing your name is to be considered your signature* *
Today's Date *
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