Walk-In Counselling

Walk-in Counselling Program 
Community Therapist Application
*All information is strictly confidential - read our Privacy Policy*
482-0198

volunteers @ thesupportnetwork.com

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I am applying as:

Volunteer (see qualifications)
Practicum Student (see qualifications)
Provisional Psychologist (see qualifications)

I have read the FAQs: Yes  No (please do!)

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

Telephone:

Hours to call:
Home:
Work:
Cell:
Emergency Contact:
Name:
Day Time Phone #:
Evening Phone #:
Cell Phone:
Relationship:
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?

Languages spoken (other than English):

Work Experience:

Please fax, mail or email a resume that includes education, employment and volunteer history to:
Coordinator of Volunteers
The Support Network
#301 11456 Jasper Avenue
Edmonton, AB T5K 0M1
Fax: 488-1495
E-mail: volunteers@thesupportnetwork.com

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?

Based on your previous experiences as a counsellor, what did you most enjoy?

What was the most difficult?

Are you accustomed to working with team feedback?

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 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

I am willing to submit to a criminal record check.
Yes  No

I am willing to submit to a Child Welfare check (CWIS).
Yes  No

I have recently lost someone close to me to suicide.
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)
E-mail address
How do you know this person?
How long have you known this person?

Name:
Phone: (home) (work)
E-mail address
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 position with The Support Network.

Last updated: October 9, 2009