Name
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First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Age
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Phone Number
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(###)
###
####
Email
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Employment Status
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Present Occupation
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Education Level
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How do you spend your leisure time?
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Have you had any prior experience with volunteer programs?
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How did you learn about NBDMC?
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Why have you chosen to become a volunteer?
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What life experiences have you had that would be useful in working with newcomers?
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Do you speak any languages other then English?
Would you allow NBDMC to recognize your contributions in public?
Provide Two References (Please provide the Name, Title, Relationship to you, Telephone number & Email address to contact reference) These references can include; previous volunteer positions, employers, educational experiences, churches and/or faith organizations, family member, friend, of which only one may be a family member.
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I authorize the North Bay & District Multicultural Centre to contact the persons/ organizations listed below for the purpose of obtaining reference information.
I understand that a Police Records Check is required as part of my screening.
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By typing your full name here, you consent to NBDMC to complete a form with all this information on your behalf. Your name typed here will be considered an electronic signature.
