Volunteer / Employment Application
YMCA-YWCA of
Vancouver Island
Application for: VOLUNTEER EMPLOYMENT
Personal Information
Surname: Given Name(s):
Home
Address: City:
Province: Postal Code:
Day Telephone Number: Night Telephone Number:
E-Mail:
Position Applying For: Date Available to Begin Volunteer / Work:
Are you legally entitled to work in Canada? Yes No
Education Information
Secondary Education
School:
Highest Grade Completed: Year:
Post-Secondary Education (University, Business, Technical)
School Name
Degree / Diploma
Majors / Specialization
Length of Course
Completed?
Yes
No
Yes
No
Yes
No
Yes
No
Other Courses, Workshops, Seminars
Course Name
Year Completed
Please Turn Over
Volunteer / Employment History (Please start with the most recent)
Name of Employer and
Address:
Position Title:
From (Month / Year):
To (Month / Year):
Responsibilities:
Reason For Leaving:
Name of Employer and
Address:
Position Title:
From (Month / Year):
To (Month / Year):
Responsibilities:
Reason For Leaving:
Name of Employer and
Address:
Position Title:
From (Month / Year):
To (Month / Year):
Responsibilities:
Reason For Leaving:
Please Turn Over
References
I authorize you to obtain references from my past and present employers / supervisors
Name
Relationship to you
Years known
Phone number
Work and Volunteer-Related Skills
Describe any of your work-related skills and / or volunteer-related skills or experience that relate to the position being
applied for.
Notice To Applicant
It is the policy of the YMCA-YWCA of Vancouver Island that applications are accepted and positions filled without regard
to the applicant's race, ancestry, place of origin, colour, ethnic origin, handicap, citizenship, creed, sex, sexual
orientation, age, record of offenses, marital status, or family status.
It is a condition of employment that all employees agree to:
1. Be bound by the policies and procedures of the YMCA-YWCA of Vancouver Island and;
2. Provide a Canadian Criminal Record Clearance letter, or permission for a criminal record check to be conducted
on his/her behalf.
The personal information collected on this application form will be used for the purposes of establishing and maintaining
the employment relationship and will not be used for any other purpose or disclosed to any third parties without first
notifying you.
The YMCA-YWCA of Vancouver Island shall protect personal information by security safeguards appropriate to the
sensitivity of the information. We will protect personal information against such risks as loss or theft, unauthorized
access, disclosure, copying, use, modification or destruction, through appropriate security measures.
The employment application form will be retained for one year in the case of an unsuccessful applicant and for twenty
(20) years if the applicant is successful and becomes an employee of the YMCA-YWCA of Vancouver Island.
I, the undersigned, declare that the information provided herein is true and complete to the best of my knowledge. I
understand that a false statement may disqualify me from employment, or cause my dismissal. I authorize any person,
educational institution, or organization I have listed as a reference to disclose in good faith any information they may
have regarding my qualifications for employment. I will hold you and any of my former employers, educational
institutions and any other persons giving references free of liability for providing this information and any other
reasonable and necessary information related to my application for employment.
Thank you for completing this application form and for your interest in employment with the
YMCA-YWCA of Vancouver Island.
Signature: Date:
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signature
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