Volunteer Distress Line

Distress Line Volunteer Application
482-0198

volunteers @ thesupportnetwork.com

*All information is strictly confidential - read our Privacy Policy*

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Name:
Address:
City:
Province:
Postal Code:
Email:

Telephone:

Hours to call:
Home:
Work:
Cell:
May we call you at work
during the day? 		Yes  No

I have read the Frequently Asked Questions about volunteering on the Distress Line Yes  No (please do!)

Are you 18 or over? Yes  No
I realize that Distress Line training is mandatory and have checked out the currently posted training dates. I am interested in attending the following session:
How did you learn about our volunteer opportunities?
Newspaper Poster/Billboard Radio
School TV Volunteer Centre
Web Site Word of Mouth Other, please specify

Have you volunteered with our agency before? Yes  No

If yes, when (approximately) and in what capacity?

Education Level Completed

Junior High School
High School
College or Technical School - Diploma received:
University - Degree received:
Post Graduate - Degree received:

Specialized course/training and, if a post-secondary student, please indicate what program and year you are currently enrolled in:

Languages spoken (other than English):

Work Experience:

Current Status:
Employed
Homemaker
Retired
Self-Employed
Semi Retired
Student
Unemployed

Employment History    
Organization Dates Occupation
Volunteer Experience    
Organization Dates Position
What other major time commitment(s) do you have?
Other relevant skills or experiences:
Emergency Contact:
Name:  
Day Time Phone #:  
Evening Phone #:  
Cell Phone:  
Relationship:  
Please explain your reasons for wanting to volunteer with The Support Network. What do you hope to get from this experience? What qualities and skills will you bring to us?
What feelings come to mind when you think about the following things?

Family Violence:

Suicide:

Child Abuse:

Sexual Assault:

Substance Abuse:

Mental Illness:

Abortion:

Sexual Orientation :

The following factors need to be considered when applying for positions with The Support Network.

Please answer yes or no to each question below:

I am willing to sign a contract, upon completion of the agency's training, which will outline the terms and conditions of my volunteer work at The Support Network.
Yes  No
I am willing to volunteer at The Support Network for at  least one year. Yes  No
Have you had a major life event or loss in the last year? Yes  No

If yes, please describe briefly:

I have a health condition that can be made worse by stress. Yes  No
If yes, please describe briefly:
I have attempted suicide in the past. Yes  No
If yes, when?
I have lost someone close to me to suicide. Yes  No
If yes, when? Relationship to Individual
I am able to provide pro-choice referrals concerning abortion if asked to by a caller.
Yes  No
Have you ever been convicted of an offense? Yes  No
If yes, what offense and when?
I am currently seeking mental health care.
Yes  No
I am willing to submit to a security clearance and child welfare check.
Yes  No
References:

Please ensure you notify your references in advance of our call.

Please provide the names of two employment, education, or volunteer-related references (not family members or friends):

Name:
Phone: (home) (work)
How do you know this person?
How long have you known this person?

Name:
Phone: (home) (work)
How do you know this person?
How long have you known this person?

Privacy Policy

The Support Network is committed to protecting the privacy of the personal information of its clients, donors, volunteers, employees and stakeholders. The Support Network values the trust of those we deal with, and of the public. We recognize that maintaining that trust requires that we be transparent and accountable in how we treat the information that you choose to share with us.

We do not share donor or volunteer lists. We do not share, without consent, personal client information with any other organization. Emergency or life threatening situations are the only exceptions to this policy.

By submitting this online form I certify that the statements provided by me are true and accurate to the best of my knowledge. I understand that any falsification on the application will result in my not being considered for a volunteer position with The Support Network.

Last updated: October 9, 2009