Volunteer Services
Winnipeg Harvest
1085 Winnipeg Ave.
Winnipeg, MB. R3E 0S2
Phone: (204) 982 - 3663
Fax: (204) 775 - 4180
Volunteer Application Form
PLEASE PRINT CLEARLY
1.
Date: ______________
Name: ____________________________________________________ D.O.B: ___/___/______
DD
MM
YYYY
Address: ______________________________________ Apt: ________ City: ____________
Postal Code: _______________ Email: ________________________________
Phone: Home: __________________ Work: _______________ Cell: __________________
Best phone to reach you: _______ Best time to call: ________ Prefer:
Email
Phone
Emergency contact (must be completed):
Contact: ______________________
Relationship: ________________________
Phone: _______________________
2.
What is your main reason for volunteering? Select up to 2:
Meet new people
Personal satisfaction
Explore career opportunities
Develop skills
Work related
Spare time
Community service hours
(court ordered)
School requirement
(required # of hours________)
Required # of hours: ___________
To be completed by: ___/___/____
DD MM YY
3.
Training
EIA volunteer benefit
Worker:_______________
Office________________
Please let choose which one best describes you:
Employed Full-time
Employed Part-time
New Immigrant
Retired
Student post-secondary
Student high school
Student Practicum
Unemployed
EIA/Social Assistance
For Office Use Only:
Date Contacted:_________________________
Assignment Available:
Yes
No
Orientation
Date:________________________
5.
What time commitment are you
Notes:____________________________________
_________________________________________
_________________________________________
_________________________________________
____
Kiosk ID: ___________________________
Area assigned: ______________________
Days/times: _________________________
Start date: __________________________
_____________________
4.
I would be interested in helping in the following area(s).
Please select your top 3 choices, number them 1st choice, 2nd choice and 3rd choice
___Communications/PR*
___Driver*
___Special Events
____Reception
___Tour Guide/ Group Host
___Sorting food
___Maintenance*
____Kitchen*
___Driver’s Helper*
___Order filling
___Computer/ I.T*
___Public Education*
___Food Bank Room*
___Agency Relations*
___Seasonal Projects
___Gardening
(*No Saturday/evening positions available)
4.
5.
What is your availability? Please indicate with a time
Monday Tuesday Wednesday Thursday
Morning
Afternoon
Evening
Friday
Saturday
Closed
What time commitment are you looking for?
1-2 shifts/week
6.
( Physical job must be able to lift 50 lbs)
3-5 shifts/week
1/month
1/every other week
6 - 9 months
9 months and over
How long of a commitment?
1 - 3 months
7.
Does your volunteer time commitment need to be flexible?
8.
Which additional languages do you speak?
French
Spanish
ASL
Yes
German
Other (Please specify): ________________________
No
Tagalog
________________________
9.
Any physical limitations?
Yes (Please specify)
No
___________________________________________________________________________
___________________________________________________________________________
10.
Can you work independently?
Yes
No
If no, will a support worker be attending with you?
Yes
No
Name of organization: __________________________ Phone: __________________
Support worker name: __________________________ Phone: __________________
11.
Can you work in a busy, loud, changing environment?
Yes
No
12.
Other organizations you have volunteered with:
_____________________________________________________________________________
_____________________________________________________________________________
13.
How did you hear about us?
Media
Website
Another volunteer
14.
Special Event
Work/School
Friend/Family
Other (please specify):__________
Have you ever been convicted of a crime?
Yes
No
If yes, please explain the nature of the crime and the date of the conviction. A conviction of a
crime is not an automatic disqualification of volunteer work.
_____________________________________________________________________________
_____________________________________________________________________________
NOTE: Depending on the position you are applying for, Winnipeg Harvest may require you to
complete a Child Abuse Registry Check/Vulnerable Sector Check and/or a Criminal Records
Check. The Volunteer Services Associate will notify you of this and Winnipeg Harvest will cover
the related costs.
15.
What are your skills/experience or talents?
Administration/Office
Forklift Operator
Advocacy
Fundraising
Call Centre
Gardening
Communications-Audio/Visual
Grant Writing
Communications-Graphic Design
Nutritionist
Communications-Website/Social Media
Photography
Computer-Data Entry
Research
Computer-General
Transport Driver
Computer-IT
Teaching/Instructing _____________
Custodial/Cleaning
Writing/Reporting
Driver’s License Class#______
Warehouse Support
Food Services-Prep/Cooking
Other_______________________
Food Services-Serving/Cleaning
____________________________
Photograph Release (Permission to use image): Do you give your consent for Winnipeg harvest
to photograph and/or film for the purpose of raising awareness of poverty issues, food collection,
time and money?
This photograph may be reproduced, used and distributed whether alone, or in connection with
other photographs in any and all manner and media perpetuity. The permitted uses include, but
are not limited to, all forms of print, electronic and multi-media reproduction including software
programs on the internet.
Yes
No
Disclaimer: It is the policy of this organization to screen all prospective volunteers to ensure the
highest level of service to our clients. This information supplied is confidential. While we try to
place every prospective volunteer, we reserve the right to reject applicants who do not meet our
requirements and/or criteria.
Release from Liability: Volunteers release Winnipeg Harvest and its agents, representatives,
trustees, officers, employees and volunteers from any liability arising out of any damage, loss or
injury to the volunteer or his/her property incurred as the result of volunteer activities.
Yes
No
The volunteer agrees:
To follow the directions of the area supervisors
To not disrupt other volunteers who are working in the building
To respect the privacy of all Winnipeg Harvest clients
To keep all information about Winnipeg Harvest clients and volunteers confidential
To obey all safety and security guidelines of Winnipeg Harvest
If any of the above guidelines are not complied with, you may be asked to leave the
premises. I consent to the disclosure and subsequent verification of information provided
by me on this application form. I certify the information set out by me in this document is
true and correct to the best of my knowledge and belief.
Yes
No
Volunteers 14 yrs of age and under require a Guardian (18+) to volunteer with them.
Signature of volunteer: _____________________________
Signature of Parent/Guardian of volunteer: _______________________________
(Parent or Guardian must sign if volunteer is under 18 years of age)