Volunteer Sign Up Form

First Name* Last Name*  
Age range: (Minimum age of volunteers: 16)
(Optional: For statistical Compilation)
Gender: * M F
Apt. no.
Postal Code
Contact Home* :
Office :
  Cellular : Fax :
Email :
Status*: Citizen Immgrant International Student
Other, please specify:

How long have you been in Canada* Yr. M Since Born
Country of Origin*:

Education Level Attained:
Elementary High school (Grade) College/University

If you are currently a student, please indicate:
School: Grade or Level:

Please describe any past training that you have done:

Current Occupation:

(Length of service: Yr M)  
Previous Occupation: (Length of service: Yr M)  

Languages that you speak and/or write
English   Chinese   Korean Punjabi Farsi Tagalog

Skills that you can use in volunteer service:

Volunteer Experience :

Reasons for volunteering at S.U.C.C.E.S.S.?

Areas Interested in Volunteering?

Administration Support Volunteer Friendly Visit Volunteer  Seniors ESL Instructor
Child Minding Helper Front-desk Receptionist Settlement Service Helper
Chinese Help Lines Volunteer Fund-raising Events Helper Summer Program Worker
Dispatch Rider Job(Employment) Mentor Translator/Interpreter
Events Helper Proof Reader, Typesetter
Evergreen News Writer/Reporter

* These items are necessary for statistical compilation.

Time Available: (Please indicate availability for volunteer service)

Sun Mon Tue Wed Thurs Fri Sat




Any Day/Time

Service Centre preferred:
Pender Granville Richmond Burnaby/Coquitlam Tri-City Surrey Burnaby

Emergency Contact:

Name: Relationship :

Home Phone: Cell Phone:


S.U.C.C.E.S.S. seeks to protect participants, client, volunteers, employees and the community throught appropriate screening measures. Both reference checks and police records checks are required dor a number of positions. I understand that I do not have to agree to these background checks, but that refusal to do so may exclude me from being considered for a voulnteer placement.

If requested, are you willing to submit a police records checks? Yes No
If requested, are you willing to provide two references (school, business or volunteer related)? Yes

By clicking on "Submit", you are agree to the following commitment:
1. I agree to adhere to S.UC.C.E.S.S.'s Volunteer Service policies, rules, and regulations,
2. I agree to attend a formal Volunteer Orientation and complete the requried training.
3. I understand that false information on this registration form may be cause for termination of volunteer services.