Volunteer Application Form Step 1 of 3 33% Applicant InformationAre you a new volunteer or a returning volunteer?(Required) New Volunteer Returning Volunteer Your Name(Required) First Last Your Email Address(Required) Your Email Confirm Email Address(Required) Street Address Address Line 2 City Province Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Your Phone(Required) Tell Us More About YourselfAre you 14 years of age or older?(Required)Children under 18 years of age require written parental consent to volunteer. Yes No Spoken Languages English French Other Written Languages English French Other Tell us why you're interested in Volunteering at the Brockville Arts Centre(Required)Are you comfortable using a computer?(Required)Volunteer scheduling is done online only and additional communication is done via email. Yes No Are you able to sit for long periods of time?(Required) Yes No Are you able to stand for long periods of time?(Required) Yes No Are you able to climb and descend stairs?(Required) Yes No Do you require any accommodations to perform the responsibilities of this role? If yes, please tell us how we can support you.This question helps us understand if an applicant requires assistance for accessibility purposes.QualificationsReferences(Required)Please provide a minimum of two (2) character or professional references. By entering their information below, you authorize the Brockville Arts Centre (City of Brockville) to contact the persons or organizations listed below for the purpose of obtaining reference information. Relatives are NOT accepted for those over the age of 18 years.NamePhone NumberEmail AddressRelationship to Applicant Add RemoveRelevant Skills & Qualifications(Required)You understand that a Criminal Record Check will be requested as a part of this application process?(Required)A valid Criminal Record Check, that is dated within six (6) months of your application, is required for all persons 18 years of age or older. I understand I understand that the Volunteer Training Session is mandatory.(Required)Training occurs every September on a yearly basis. Dates will be announced. I understand Terms and Conditions(Required)Personal information, as defined by the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA) is collected under the authority of the Municipal Act, 2011, and in accordance with the provisions of the MFIPPA. Personal information on this form will be used to assess the applicant’s eligibility for volunteer positions or qualifications for appointment to one of the various committees or boards. At no time will your personal information be disclosed without your express written consent. Questions regarding the collection, use and disclosure of this personal information may be directed to the Freedom of Information Coordinator, Clerk’s Office, 1 King Street West, Brockville, ON K6V 7A5, 613-342-8772. Declaration: I hereby declare that the foregoing information is true and complete to my knowledge. I understand that a false statement may disqualify me from volunteering, or may cause my dismissal from volunteering. I agree to the terms and conditions.Volunteer Applications are kept on file for 12 months from date of submission.Date MM slash DD slash YYYY
