Volunteer Application

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Full Name *

Street Address *

Apt. Suite, Bldg. (optional)

City *

State / Province / Region *

Postal Code *

Country *

Home Phone *

Cell Phone

Email *

Emergency Contact #1 Name *

Emergency Contact #2 Name

Emergency Contact #3 Name

Emergency Contact #4 Name

Phone Number #1 *

Phone Number #2

Phone Number #3

Phone Number #4

Relationship #1 *

Relationship #2

Relationship #3

Relationship #4

Abilities & Skills *

Transportation Driver
Meals on Wheels Delivery
Day Away Program
Day Away Driver
Day Away Entertainment
Friendly Visiting
Fundraising & Events
Virtual Volunteering (online)
Board of Directors
Other

If other, please describe:

When is the best time to reach you? *

Morning
Afternoon
Evening

Are you a smoker? *

Are you affected by any special health restrictions which limit the kind of volunteer work that you may perform? *

No
Yes (please describe)

Describe any health restrictions

Date of Birth (mm/dd/yyyy) *

Interests, Hobbies & Background

References

Please list three people who have knowledge of your qualifications. References should have known you for at least two years and can not be immediate family.

Reference #1 Name *

Reference #2 Name *

Reference #3 Name *

Relationship #1 *

Relationship #2 *

Relationship #3 *

Phone Number #1 *

Phone Number #2 *

Phone Number #3 *

Length of Time Known #1 *

Length of Time Known #2 *

Length of Time Known #3 *

How did you hear about volunteer opportunities for Home & Community Support Services Grey-Bruce?

Newspaper
Radio
Poster
Internet
Word of Mouth
Other

If other, please describe:

I give my permission for the references above to be contacted in connection with my application for a volunteer position with Home & Community Support Services. I understand that the screening process of HCSS Grey-Bruce includes an application form, an interview and reference checks. Upon receipt of a conditional offer of a position I understand that some positions may also require additional checks such as driving licenses, insurance confirmation, and police checks. *

I agree

I give my permission to Home & Community Support Services Grey-Bruce to communicate with me via email and mail. *

I agree

I give my permission to Home & Community Support Services Grey-Bruce to use my photo for publicity purposes, which may include but is not limited to Media, Newspapers, Social Media, Presentations, and Newsletters. All permissions are in effect until directed otherwise, in writing to the HCSS Grey-Bruce Privacy Officer.

I agree

Please print your full name: *

How Our Service Works

If you are new to HCSS and would like access one of our programs or services, register with us by calling the central intake office at 1-833-659-5491.

Afterward, please contact us to arrange your service.