Volunteer Application Form

Please complete all parts of this form. This form will remain on file at Avenue B. All volunteer information and files are kept strictly confidential, available only to authorized Avenue B staff and volunteers who have signed a confidentiality agreement. If you have any questions about this application, please call 652-2437 or email avenueb@avenueb.ca

Name: *

First Name Last Name

Birth Date

Month Day Year

Primary Phone Number: *

Area Code Phone Number

Secondary Phone Number

Area Code Phone Number

E-mail Address:

Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Have you ever been convicted of a criminal offense for which you have not been pardoned? (If yes, applicant may still be considered for a volunteer position

Yes No

How did you hear about Avenue B?

Why are you interested in volunteering for Avenue B?

Do you have any concerns about HIV/AIDS, Hep C or any other STBBIs?

We work with diverse populations such as persons living with HIV/AIDS, young people, injection drug users, gay men, Aboriginal persons, etc. Sensitivity to diverse individuals and populations is essential. Are you comfortable working with diverse groups? Please explain.

How would you rate your level of comfort discussing sexuality?

	1	2	3	4	5

1 is Very Difficult, 5 is No Difficulty

Highest completed level of Education

High School/GED University Undergraduate Community College Masters/PhD

Please list any specialized training qualifications (professional degrees, first aid, computer courses, certificates, etc.)

Please indicate any languages that you read, write, or speak.

In your current job, would you be in a conflict of interest if you were to work in our office or at our Needle Exchange? (For instance, are you required to report clients who you know are using drugs?)

Yes No

Please indicate which volunteer areas you are most interested in.

Board of Directors: The Board governs on behalf of the organization’s membership and is responsible for developing the by-laws and policies of the organization. The Board is accountable to the organizations funders. The Board meets monthly.

Board of Directors

	1	2	3	4	5

1 is Not Interested, 5 is Very Interested

Speakers: Are you interested in respresenting Avenue B at various education/information displays at schools, conferences, workshops, community events, etc?

Speakers

	1	2	3	4	5

1 is Not Interested, 5 is Very Interested

Walk in Programs: general office support work, Needle Exchange Program.

Walk in Programs

	1	2	3	4	5

1 is Not Interested, 5 is Very Interested

Special Events: be involved with special events such as the AIDS Walk, The Red Scarf Campaign, Auctions, etc.

Special Events

	1	2	3	4	5

1 is Not Interested, 5 is Very Interested

Please include one personal and one professional reference, if possible.

Name

First Name Last Name

Phone Number

Area Code Phone Number

Name:

First Name Last Name

Phone Number

Area Code Phone Number

Avenue B Volunteer Application

Personal Information

Volunteer Areas

References