Become a Volunteer

QUAIL  Quebec Association for Independent Living, 
9 ch Bois Joli, Chelsea, Qc, J9B 1J9

 

   Please complete the following information
(all information will remain confidential)

First name:  
Surname: 
Street:   
City: 
Province:   
Postal code
Home telephone
Work telephone
Fax
Email address
Emergency contact
Emergency contact Relationship
Emergency contact Tel Home
Emergency contact Tel Work
Languages
                       English
                       French
Skills & Interests
Educational background
Current employer
Work experience
Hobbies, skills, interests
Previous volunteer experience Yes No
If yes, name of organization
May we contact someone there? Yes No
Name and telephone number
Preferences in volunteering
No preference
Working one-on-one with a single client (movies, walking, shopping, physical fitness, etc.)
Providing assistance to several clients
Driving residents
Special occasions
Skills teaching
Gardening
Tutoring, reading, etc.
Do you have any physical disability or illness, which would need to be considered in any volunteer position? If yes, please specify:
Have you been immunized against Hepatitis B? Yes No
Have you ever served as a volunteer with us before? Yes No
Is there a person or group with whom you are particularly interested in volunteering?
No preference
Male
Female
Availability
I'm flexible
Prefer weekdays
Prefer evenings
Prefer weekends
Other:
Do you have access to a vehicle that you can use for volunteer work? Yes No
 
References
Please list two non-family references that you have known for two years that we may contact.

1st reference
Name
Home telephone
Email address
 

2nd reference
Name
Home telephone
Email address
 
You heard about us from
a staff member
a friend / volunteer
a resident of QUAIL
other (please specify):
Authorization

Please check here if you agree to the following:
I, hereby give permission for the volunteer coordinator of QUAIL to contact the references listed in regards to my volunteer application. I understand that a police background and driving record check will be conducted as required.
 
Declaration

Please check here if you agree to the following:
I, hereby declare that the information provided on this form is correct to the best of my knowledge and I understand that any false statement may disqualify me from acceptance into the volunteer program.

            

QUAIL
9 ch Bois Joli,  Chelsea, Qc, J9B 1J9


Pavillon du Parc, 124, rue Lois, Gatineau, QC, J8Y 3R7
Tel.: (819) 770-1022  Fax : (819) 770-1023
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