EmailMe Form - Volunteer Form

EmailMeForm

Name *
First Last
Phone Number *
### - ### - ####
Email *
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Staff will check in periodically. Please select your preferred method(s) of communication: *
Phone Call
Email
Text
Check if applicable:
Post Secondary Student
High School Student
Part of matching you with a community participant is determining if your availability matches with theirs. Check the boxes of the times/days you are available to make calls:

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Morning (9am - 12pm)

Afternoon (12pm - 4pm)

Evening (4pm - 8pm)
Language(s) spoken:
How many calls (of approx. 15 mins - 1 hour) are you consistently able to make per week: *
Please list any training, experiencing or certificates that may be an asset in this position (for example, Mental Health First Aid, Suicide Intervention Training, etc.)
References
Please provide 2 references for the Volunteer Coordinator to contact
Personal Reference *

Name:

Phone:

Email:

How long have you known this person:

Relationship to you:

*Must have known you for at least 1 year
Professional Reference *

Name:

Phone:

Email:

How long have you known this person:

Relationship to you:

*must be from volunteer or paid experience from the last 5 years
*
I give permission for Canadian Mental Health Association to contact my references
*
I herby certify that all the information in this form is true and complete
Confidentiality
Check ALL boxes below to signify your agreement
During your enrollment, you may receive confidential information about community members and/or Canadian Mental Health Association. As such, all volunteers agree to: *
Take precautions to protect and maintain all confidential information.
Complete the online FOIP (Freedom of Information and Protection of Privacy) Act training.
Only release confidential information to those authorized to receive it, and only on a need-to-know basis.
Not disclose, discuss, publish, or disseminate (including on social media) confidential information to any unauthorized persons, including the media.
When your volunteer position ends, you must return all materials or property. You must agree not to retain, reproduce, or use any confidential information or proprietary information belonging to the organization.
*
I herby certify that all the information in this form is true and complete
Next Steps
You will be emailed with a letter to use for a Police Intervention Check with Vulnerable Sector to receive the volunteer cost of $15.

Once your application has been received it will be processed and you will receive a call to complete a phone interview (approx. 30 mins). After the interview, your references will be contacted and you must complete a Police Intervention Check. Once complete, you will be contacted for training.

CMHA will cover the cost of the Police Information Check with Vulnerable Sector. You must keep the receipt and submit it with the completed Vulnerable Sector Check. No receipt, no reimbursement.

Any questions, contact kitprogram@cmha-aser.ca

Name:
Phone:
Email:
How long have you known this person:
Relationship to you:

Name:
Phone:
Email:
How long have you known this person:
Relationship to you:

EMF Free Form Builder

Report Abuse

	Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
Morning (9am - 12pm)
Afternoon (12pm - 4pm)
Evening (4pm - 8pm)

References

Confidentiality

Next Steps