_______________________________________________________________________________________ A – CONTACT INFORMATION: First Name ___________________________ Last Name __________________________________________
Address __________________________________________________________________ Apt #__________
City _______________________________ Province______________________ Postal Code_____________
Home Phone________________________________________ (can we leave a detailed message about who we are: Yes /No)
Work Phone _________________________________
Languages spoken: English French Other ________________________________________
Languages written: English French Other ________________________________________
Emergency Contact Name _______________________ Phone _____________Relationship_____________
B – KNOWLEDGE ABOUT BLACK CAP: How did you learn about Black CAP?
From Newspaper, Magazine, Television Health Care Provider Telephone Book
Volunteer/employment centre Internet/web-site Black CAP Staff
Why do you want to volunteer for Black CAP? (Check all that apply)
Support the cause Meet new people
Apply skills Community service Other____________________________________
Develop skills Internship
C – SKILLS PROFILE: Occupation _______________________________ Employer (Optional) ______________________________
Previous/present volunteer or work experiences__________________________________________________
What skills would you apply in a volunteer role with us?
Workshop Facilitation Word Processing Special Events Promotion
Practical Support Desktop Publishing Translation/Interpreter Service
Leadership skills Media Other________________ Please turn-over
D – VOLUNTEER OPPORTUNITIES: Please check your area(s) of interest. Indicate your preference by ordering them #1, 2, 3, etc.
Administration/Reception Event/Planning Committee Work
Club/Bar/Bathhouse Support Department Board of Directors
General Outreach Education/Prevention Immigration & Settlement
Fundraising Harm Reduction LGBT
E – AVAILABILITY: Please mark below (√) the days/times you are available to volunteer
Time of Day
F – REFERENCES: Please provide the name of personal or professional reference
Name _______________________________ Phone _____________________ Relationship______________
G – VOLUNTEER AGREEMENT: At all times, the privacy and dignity of clients, donors, volunteers and staff will be respected, and the mission, vision and philosophy of the Black Coalition for AIDS Prevention will be followed in accordance with the Black CAP’s policies, standards and guidelines. As a volunteer of the Black Coalition for AIDS Prevention, you may have access to information and documents relating to clients, donors, volunteers and staff that are private and confidential in nature. All volunteer and client records are the property of Black CAP and will be treated as confidential material; reasonable care and caution should be exercised to protect and maintain total confidentiality. No person shall read records or discuss such information unless there is legitimate purpose. Volunteer and client interactions shall not be discussed with people outside Black CAP, including immediate family members, throughout and beyond tenure with Black CAP.
By signing below, you acknowledge that the information provided is true and accurate, and that you have read, understand, and will abide by the agreement above. And, by signing below, you grant the Black Coalition for AIDS Prevention permission to contact the references listed. Signature ________________________ Date _____________________________________ Signature of Parents/Guardian (if under 18years old) __________________ Date ___________ OUR POLICY:
It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual orientation, age or disability.