Volunteers in Education

JUMP Application (Ottawa Area)

General Information

Date:
	Mr. Mrs. Ms. Miss
First Name:
Last Name:
Address:
City:
Postal Code:
Business:
Home:
Email:
Emergency Contact:
Business Telephone:
Home Telephone:
Are you willing to undergo a Police Records check (more info)?	Yes No

Volunteer Classification:

Senior/Retired University Student Parent Community

Languages:

Spoken: English French
Other (specify)

Written: English French
Other (specify)

Availability
Days and times preferred:

	Mon.	Tue.	Wed.	Thu.	Fri.	Flexible
AM
PM

Name of School(s) Preferred (if known):

Mode of Transportation:

How did you learn about the program?

Friend	Media	Volunteer Ottawa
School or Board	University Student Services
Ocri Web Sites	Other (specify)

Personal History:

Education and/or work experience: (Please list)

Volunteer experience:

References

I hereby authorize OCRI - Volunteers in Education to solicit a personal reference from the two following adults who are in a position to comment on my character, temperament or work habits. By checking Yes, I hereby give OCRI-Volunteers In Education permission to contact the references below. Yes

Reference 1:
Name:
Relationship:
Day Tel:
Reference 2:
Name:
Relationship:
Day Tel:

Declaration

By checking Yes, I hereby declare that all information I have provided in this application is true and complete to the best of my knowledge. Yes

By checking Yes, I understand and accept that my application may be declined in any of the selection and/or placement processes. Yes

Click the submit button below to send your application online. Or return to OCRI by fax at 613-726-3443 or by mail to:

Volunteers In Education
OCRI
2625 Queensview Drive, Suite 200
Ottawa, Ontario
CANADA
K2B 8K2