Volunteer Application Form – Land O'Lakes Community Services

Name *

Street Address *

Mailing Address (if different from street address) *

City / Province / Postal Code *

Phone Number *

Date of Birth (mm/md/yyyy)

E-Mail Address *

Emergency Contact #1-Name

Emergency Contact #1-Relationship

Emergency Contact #1-Phone Number

Emergency Contact #2-Name

Emergency Contact #2-Relationship

Emergency Contact #2-Phone Number

Tell us which areas you are interested in volunteering:

Text

During which hours are you available for volunteer assignments?

Do you have a valid drivers license?

Yes

No

What kind of vehicle do you drive?

Van

Car

Truck

SUV

What type of vehicle access?

2 dr

4 dr

Is smoking permitted in the vehicle?

Yes

No

Vehicle Colour:

Vehicle make / model:

Summarize special skills and qualifications you have acquired form employment or through other activities, including hobbies or sports.

Have you had any previos experience as a volunteer?

Yes

No

What organizations have you volunteered with?

What kind of work did you do as a volunteer?

Who were your supervisors? (please include contact number and or email)

Summarize any special considerations Land O’Lakes Community Services must be made aware of. Example: Cannot drive after sunset or cannot do any heavy lifting.

How did you hear about us?

List the names of 2 references and their contact number. (no relatives) *

Agreement

Signature

Date

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