Volunteer Application

Volunteer Application Form
Last Name
First Name
Address line 1
Address line 2
Postal Code/Zip
Phone (Primary)
Phone (Secondary)
What is the best time to reach you?
Date of Birth
/ /
Please identify and rate your spoken languages:
(1 = Poor and 5 = Fluent)
Education and Work Experience:
Level of Education:
(Indicate highest degree achieved)
Are you presently attending courses?
Which Program:
Date graduated/anticipated graduation date:
Other relevant studies/training:
Employment Status:
Are you currently employed?
Employed Since (Date)
/ /
Organization/Employer’s name:
What other job experience do you have?
(If retired, please describe your last employment responsibilities)
What are your hobbies and interests?
What, if any, is your past experience with volunteering (where, with what population, what did you do)?
Please describe what you have learned or accomplished through these volunteer activities:
Volunteering at Agence Ometz
How did you hear about Ometz
Which volunteer opportunity interests you and why?
What qualities, skills, experiences or other attributes do you feel you have that will benefit youth and/or the volunteer position that interests you?:
How many hours per week do you wish to give?
Do you have a car?
When are you available?
What age group would you prefer working with?
References (personal or professional)
Name - Reference 1
Please note that family members cannot be used as a reference.
Reference 1 - E-mail address:
Relationship - Reference 1
Name - Reference 2
Reference 2 - E-mail address:
Relationship - Reference 2
Police Check
I authorize Agence Ometz to submit a police check form for verification by the Montreal Urban Community Police.
Electronic Signature
I certify that the information provided is complete and accurate to the best of my knowledge.
As part of my volunteer responsibilities with Ometz:
I agree to keep my Supervisor informed, with regular weekly or bi-weekly logs, on the progress made. Failure to do so, jeopardizes the quality of the match, and can result in termination of my volunteer position.
I will hold confidential all information entrusted to me by Ometz and Ometz clients.