Application Form

Personal Information

Name

First Name:*

Last Name:*

Home

Address:*

City:*

Province:*

Postal Code:*

Contact Information

Phone Number:*

Alternate Phone Number:

Email:*

Status

What is your employment status?
Student
Employed
Unemployed
Retired

What is your status in Canada?*
Citizen Permanent Resident Working Holiday Visa Work Permit Student Visa

If you are here on a visa, what is the termination date of your visa?

Emergency Contact

Name of Emergency Contact

Emergency Contact Phone Number

Language Skills

How fluent are you English:*
Speaking:
Fluent Semi-Fluent Conversation Level Basic Understanding None

Writing:
Fluent Semi-Fluent Conversation Level Basic Understanding None

Reading:
Fluent Semi-Fluent Conversation Level Basic Understanding None

How fluent are you Japanese:*
Speaking:
Fluent Semi-Fluent Conversation Level Basic Understanding None

Writing:
Fluent Semi-Fluent Conversation Level Basic Understanding None

Reading:
Fluent Semi-Fluent Conversation Level Basic Understanding None

Availability

Please Click the Checkboxes Corresponding to when you are Available. This section is required

How long would you like to volunteer with us? (minimum six months)*
Months:

Hours per Week:

Volunteer Interests

Please Select which Volunteer Positions you are Interested In. Check the boxes in row containing positions you are interested in

Why are you interested in the positions you have marked?*

Experience

Do you play any instruments?

Do you like to sing?

What type of music do you enjoy

What type of art do you enjoy

Have you ever worked with seniors before?
Yes
No

Please provide two references*

Do you agree to a criminal record check?*

The criminal record search is limited to the specified offences listed in the Criminal Records Review Act for the purpose of working with vulnerable adults

Yes