VOLUNTEER APPLICATION

Part A: General Information

Surname:                                                                   Given Names:

___________________________________            __________________________________

Mailing Address:

____________________________________________________________________________

Phone # where we can best contact you:                   Alternate Phone #:

___________________________________            __________________________________

How did you hear about Ah-shawah-bin Sioux Lookout/Lac Seul Victim Support Services?

 ____________________________________________________________________________

Part B: Background Information (include all your skills related to victimization and justice issues, and crisis intervention)

Education: (include the highest level completed, relevant courses or training)

___________________________________________________________________________________________________________________________________

Employment: (present or most recent, and any related experience)

___________________________________________________________________________________________________________________________________

Volunteer Experience:

___________________________________________________________________________________________________________________________________

Community Involvement (if any):

___________________________________________________________________________________________________________________________________

Recreation / Hobbies:

___________________________________________________________________________________________________________________________________

Related Skills (e.g. American Sign Language, cultural/spiritual understanding, languages):

___________________________________________________________________________________________________________________________________


Please outline why you are interested in volunteering with Ah-shawah-bin Sioux Lookout/Lac Seul Victim Support Services.

___________________________________________________________________________________________________________________________________

Part C: Availability
Ah-shawah-bin is a 24 hours per day, seven days per week, on-call service. Volunteers are required to commit to two 12 hour shifts per month. When are you available to volunteer? Please circle all that apply to you.

Days     Evenings     Nights     Weekdays     Weekends     Anytime

________________________________________________________

Part D: References
List three references whom you authorize Ah-shawah-bin Sioux Lookout/Lac Seul Victim Support Services to contact for the purpose of obtaining reference information. These persons are authorized to disclose such information:

  Name                    Organization                    Position                    Title                    Contact Ph.#

1)_______________________________________________________________________________________________________________________________________


2)_______________________________________________________________________________________________________________________________________


3)_______________________________________________________________________________________________________________________________________


VOLUNTEER SIGNATURE:________________________________________________

DATE:_________________________

Completed forms may be faxed to (807) 737-1701 or emailed to ahshawbin@sioux-online.com or
mailed to the following address:

Ah-shawah-bin Sioux Lookout/Lac Seul Victim Support Services
Box 1327, 56-C Front Street
Sioux Lookout, Ontario.
P8T 1B8