Volunteer Application Form

PERSONAL INFORMATION

If you answered with "other," please write your response here:

First name:

Last name:

Address. Example: 259 Foster Thurston Drive, Saint John, New Brunswick, E2J 1K3.

Mailing/Delivery address (if different from above):

EMERGENCY CONTACT:

Contact Name:

Relationship to Volunteer:

Phone Number:

YOUR AVAILABILITY

Are there times during the year that you are unable to volunteer (e.g. summer, March Break)?

YOUR PREFERENCES

Are you interested in volunteering on a (check one):

Short-term basis (up to 6 months)

Longer-term basis (longer than 6 months)

Seasonal/Occasional basis (as needed & available)

Regular basis (in the office)

CURRENT EMPLOYMENT

Employer name:

Please list your position, department and division:

The address of your place of employment. Example: 259 Foster Thurston Drive, Saint John, New Brunswick, E2J 1K3.

COMMUNITY AFFILIATIONS

Please list any Service Clubs and/or other charities you volunteer with:

OTHER INFORMATION

Please list two people as references. One can be a personal reference; one must be a professional reference. Please include their name, phone number and how many years they've known you.

VOLUNTEER AGREEMENT – Please read the following and check to verify that you have read the information:

1. I understand that my participation is purely voluntary and that there will be no financial remuneration whatsoever.

2. I understand while representing the Heart and Stroke Foundation of New Brunswick I must conduct myself in an acceptable and professional

3. If accepted as a volunteer, I agree to sign a confidentiality agreement.

4. If accepted as a volunteer, I agree to provide the Heart and Stroke Foundation of New Brunswick a Criminal Record Check / Vulnerable Sector Check.