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SAFETY EXIT
Your Details
Full Name
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Email
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Primary Phone
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Other Phone
Street Address
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Apartment, suite, etc
City
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State/Province
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ZIP / Postal Code
Date
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Emergency Contact:
Emergency Contact Name
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Street Address
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Apartment, suite, etc
City
State/Province
Phone
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Email Address
Please choose one:
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a) VOLUNTEER: I am applying as an adult volunteer (age 18 and over)
b) STUDENT: I am applying as a student age 14 to 17, and my volunteer hours will go toward my Secondary School Community Volunteer hours.
When are you available? Choose as many as apply to you.
Anytime
Mornings
Afternoons
Weekdays
Weekends
Other
It is understood that circumstances may change, and you may choose to add or decrease participation.
Getting To Know You
a) Tell us a bit about yourself...
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b) Have you ever volunteered before?
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c) Why have you chosen Bethesda House / The Second Chance store as a place to volunteer?
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References
Reference 1 Name
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Professional or past volunteer references are preferred. Students, teacher references are sufficient if not past experience.
Phone
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Email Address
Relationship
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Reference 2 Name
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Professional or past volunteer references are preferred. Students, teacher references are sufficient if not past experience.
Phone
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Email Address
Relationship
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Police Check
*not applicable to students
I understand that as a Bethesda House Volunteer I am required to submit an acceptable police check (Vulnerable Sector)
Please choose one:
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a) I have submitted my check / am submitting my check today
b) I will apply for my check immediately / or am waiting for my check to arrive
c) I am 14 - 17 years old and am not required to have a police check
If b), as a prospective volunteer, I confirm that there will be nothing on my police check that will preclude me from being eligible to be a Bethesda House volunteer.
Yes I confirm
No I can not confirm
If an offence is documented on the police check...
Bethesda House understands and agrees that under the Ontario’s Human Rights Code, every person has a right to equal treatment with respect to record of offences. If an offence is disclosed, the Bethesda House Executive Director and Store Coordinator will meet with the volunteer to discuss:
• Is the offence being declared sufficiently related to the individual’s specific employment or volunteer role to need to take into consideration?
• Are there mitigating or extenuating circumstances?
• Have rehabilitation efforts been demonstrated?
• Has a pardon or record suspension been secured?
• Has a conditional discharge been successfully received?
• If the behavior for which the charge was laid is repeated, will it negatively affect Bethesda House’s reputation or the ability to carry on its business?
Your Signature
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Today's Date
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Reviewed By:
Date
SUBMIT