Volunteer Application Form

The aim of the CSCHN’s volunteering program is to promote the health of the Francophone community by offering individuals the opportunity to play an active role in their own well-being and the well-being of their community through various forms of volunteering.

Thanks to the Ontario Trillium Foundation, this program has forged partnerships with other organizations that need the help of French-speaking volunteers. These partnerships therefore open up a wider range of opportunities for volunteers while enabling organizations to benefit from easier access to volunteers with the necessary language skills.

With this online application form, we will be able to add your name to our bank of French-speaking volunteers and, knowing your personal interests and availability, match you with the role that suits you best.

Once you have completed the form, click “Submit”; you will receive an automatic confirmation that your form has been submitted successfully.

If you experience any difficulties with the form, please contact Kankou Camara at kankou.camara@cschn.ca or 905-734-1141 ext. 2351 / 1-866-885-5947. You may also email r-h@cschn.ca or call 905-734-1141 / 1-866-885-5947.

Consentement

Contrat

Formulaire de messagerie par courriel

Permission parent

Protocole de confidentialité

Confidentiality

The Centre de santé communautaire Hamilton/Niagara (CSCHN) recognizes the importance of protecting the privacy of the personal information with which it is entrusted. By personal information, we mean any information that identifies you directly, such as your full name, home address, email address or phone number, as well as any comments you may make regarding the CSCHN.

The personal information we collect from you is used to draw up the official list of CSCHN volunteers. Your information may be shared with certain employees who may contact you about volunteering for the CSCHN. A CSCHN volunteer or employee may also contact you to provide you with information regarding events that may be of interest to you as a volunteer. Rest assured that your personal information, such as your name and contact details, will not be shared or sold to anyone without your express permission and except for the purposes mentioned above.

We also collect information that cannot be used to identify you personally, such as your age group, skills and interests, in order to gain an overall picture of the CSCHN’s volunteer pool and meet the requirements of specific volunteer roles. Please contact Mr. Bonaventure Otshudi, Acting Executive Director, for further information regarding the CSCHN’s policies and practices concerning the collection, use and disclosure of personal information. If you would like your email address to be removed from our database, please send a message containing the words “ANNULER COURRIER” to kankou.camara@cschn.ca or r-h@cschn.ca. Please allow two to three working days for the cancellation to take effect.

Register

Volunteer registration form

Your name *

First name

Last name *

Last name

Date of Birth (if applicable) *

Month

Date of Birth - Day *

Day

Address

Address *

Town *

Postal code *

Phone number where we can reach you *

Email address *

In case of emergency, contact person *

Name

Phone *

Phone

Languages spoken

French

English

OtherOther

What is your status in Canada?

Training completed in the last two years

First aid training Cardiopulmonary resuscitation training

Cardiopulmonary resuscitation training

Please check the boxes if you have taken these courses

Indicate here any health or physical condition(s) that may limit your involvement in the chosen activity

e.g. inability to lift weights

References *

Please provide two non-family references (include name, relationship and contact information)

The Centre de santé has established partnerships with organizations, schools and daycares that also require the assistance of French-speaking volunteers. Do you agree that the CSCHN may share the information on your application form with these community partners?

Yes, I agree that the CSCHN may share my information with its community partners

No, I do not want the CSCHN to share my information with its community partners

Please note that community partners of the volunteer program have all signed a confidentiality agreement regarding the use of volunteers' personal information

I certify that all information provided on this volunteer application, to the best of my knowledge, is true and accurate. I understand that making false statements on this form would prevent me from being accepted as a volunteer at CSCHN. If my application is successful, I understand that I will be required to provide the Centre de santé with a criminal record check. *

Please enter your name if you agree to these conditions.

Criminal Record Check *

Yes, I can provide you with a criminal record check

No, I have not had a criminal record check in the past year

A criminal record check is mandatory for volunteers who work directly with clients at the CSCHN. This process is necessary to ensure the safety and protection of both clients and other volunteers and staff. If you have a criminal record check completed in the last year, please indicate it.

E-mail

Address

City

Department

Postal Code

Pays

Captcha

Volunteer Application Form

Volunteer Application Form

Confidentiality

Register

Address

Your skills and interests

Your availability