Volunteer Application - Brant-Brantford Crime Stoppers

Personal Information

Given Name

Surname

Date of Birth

Home Address

City

Postal Code

Email Address

Contact Telephone Number

Contact Telephone Number Type

Cellphone Homephone

Have you ever been convicted of a criminal offence?

Yes No

Person to Notify in Case of Emergency

Name

Home Address

City and Postal Code

Contact Telephone Number

Employment Information

Employed By

Job Title

Business Address

Business Contact Number

Business Fax Number

Business Email Address

References

Professional Reference

Name

Company

Telephone

Email

Personal Reference

Name

Relation

Telephone

Email

Volunteer Information

Referred by: (Board Member(s):

Summarize your previous or current volunteer experience if any:

About Section

Why are you interested in Crime Stoppers and how do you feel you can contribute?

Summarize special skills and qualifications you have acquired from employment, previous volunteer experience, or through other activities, including hobbies or sports.

Have you ever been affiliated with Crime Stoppers in the past in any capacity?

No Yes

If yes, please explain:

Additional Information Section:

PLEASE READ THE FOLLOWING BEFORE SIGNING

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.

I HAVE READ THE ABOVE AND AGREE TO ABIDE WITH THE CONDITIONS AS SET OUT THEREIN:

Virtual Signature - Full Name:

Date: