What are you applying for?

Please indicate the volunteer opportunity you are applying for by providing the reference number (this highlighted number can be found on the posting to the right of the position title):
*Reference Number:

Personal Information

Please fill out the form below. * are required fields.

*First Name:		*Last Name:
*Address:		*City:
Province:	Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northest Territories Nova Soctia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon	Postal Code:
*Email:		Phone Number:
*Birth Date:	Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

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Emergency Contact Information

Name: Phone: Relationship:

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Volunteer Experience

Role: Dates:

Duties:

Have you ever volunteered for the YMCA before? Yes

What skills/qualifications do you have?

What skills would you like to develop as a volunteer?

What are your specific interests/hobbies?

AGREEMENT TO COMMITMENT

Do you agree to attend on-going training (initial training plus workshops) as required? YesNo

I understand that I will have to submit a Police Security Clearance and Child Welfare Check YesNo

Is this a requirement for volunteer hours? YesNo
* If yes, please contact your local YMCA directly for mandated/contracted volunteering.

I hereby certify that all information included in this application form is true and complete.

I understand that providing false information is grounds for immediate disqualification from the application process, or even immediate dismissal if the falsehood is discovered after hiring.

*Upload your resume:
*DOC/DOCX/PDF/WPD* Supported

Signature: Date: