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PROTECTED WHEN COMPLETED
Volunteer Application Form Summer 2012
SECTION 1APPLICANT INFORMATION
NEW VOLUNTEER
RETURNING VOLUNTEER
MALE
FEMALE
DATE OF BIRTH (MM/DD/YYYY)
FIRST NAME LAST NAME
ADDRESS
CITY PROVINCE POSTAL CODE
TELEPHONE NUMBER (HOME) TELEPHONE NUMBER (WORK) TELEPHONE NUMBER
(CELL)
EMAIL ADDRESS
EMERGENCY CONTACT TELEPHONE NUMBER
LANGUAGES
ENGLISH
SPOKEN
WRITTEN
FRENCH
SPOKEN
WRITTEN
OTHER (SPECIFY)_____________________________
SPOKEN
WRITTEN
CORRESPONDENCE
ENGLISH
FRENCH
DO YOU HAVE ANY PHYSICAL OR OTHER NEEDS THAT SHOULD BE TAKEN
INTO CONSIDERATION?
YES NO IF YES, PLEASE SPECIFY BELOW
Your voluntary response to the questions below will assist us in
determining whether the National Capital Commission (NCC)Volunteer
Centre is becoming a more diverse place.
WHAT IS YOUR COUNTRY OF BIRTH? WHEN DID YOU ARRIVE IN
CANADA?
SECTION 2RELEASE OF LIABILITY AND PERMISSION REGARDING
PICTURESSCREENING PROCESS The NCC complies with the provisions of
the government security policy in relation to security clearances.
Onbehalf of the departmental security officer, the NCCs Security
Service must conduct an initial criminal records check for all
volunteersover the age of 16. Fingerprint identification may also
be required.
UNDERTAKING TO ACT IN ARESPONSIBLE AND SAFE MANNER In accordance
with the current Code of Conduct, I hereby undertake andagree to
act in a responsible and safe manner at all times, while acting as
an NCC volunteer.
INSURANCE
The NCC maintains insurance to the benefit of its volunteers
while they are acting as such. This insurance coverage is foclaims
arising out of injuries to third parties which are caused by the
negligence of the volunteer and for accidental death
ordismemberment of a volunteer that occurs in the course of NCC
volunteer activities.
PERMISSION TO USE PICTURES I hereby grant to the NCC and persons
acting on its behalf the unrestricted and perpetual right
andpermission, in respect of pictures or film footage that it,
through its photographers and/or contractors, has taken of me or in
which I maybe included with others, to use, to publish, to
broadcast and to authorize a third party to use, publish or
broadcast the same in whole orin part, in any and all media now or
hereafter known, for the purpose of promoting volunteerism, the
NCC, the capital and/or Canada.
I acknowledge that I have read and understood the above.
x x
APPLICANT SIGNATUREPARENT/GUARDIAN SIGNATURE
(IF VOLUNTEER IS UNDER AGE 18)DATE
NCC-CCN | 40 Elgin Street, Ottawa Ontario K1P 1C7 |
www.canadascapital.gc.caPage 1 of 2 volunteer-form-VC-04-201
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11/30/1996
Jeff Zhang
125 Bren Maur Road
Ottawa Ontario K2J0X6
6138431888 6139790198
[email protected]
Charlie Zhang 6138431888
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China 2000
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NCC-CCN | 40 Elgin Street, Ottawa Ontario K1P 1C7 |
www.canadascapital.gc.caPage 2 of 2 volunteer-form-VC-04-201
SECTION 3-VOLUNTEERING OPPORTUNITIES
Important for volunteer opportunities! Please number your
choices in order of preference (1, 2, 3, etc.) so that we can offer
youyour second choice, in the event that your first choice is not
available.
ACTIVITY 1.CANADA DAY (JULY 1,2012)
MAJORS HILL PARK
___ Logistics
___ Information officer (must be bilingual:
English and French)
___ Distribution___ Host(ess)
___ Crowd control
___ Activity assistant
___ Chicken tent
___ Green Team
___ No preference
PARLIAMENT HILL
___ Logistics
___ Information officer (must be bilingual:
English and French)
___ Distribution___ Host(ess)
___ Crowd control
___ Green Team
___ No preference
JACQUES-CARTIER PARK
___ Logistics
___ Information officer (must be bilingual:
English and French)
___ Distribution___ Host(ess)
___ Crowd control
___ Activity assistant
___ Green Team
___ No preference
T-Shirt Size Specify: ______________________
Please check off the activities you would prefer.
ACTIVITY 2.MAPLELAWN GARDEN (APRIL TO OCTOBER)
___ Gardener Perform general flower-gardening duties (weeding,
Gardener planting, etc.).
ACTIVITY 3.MACKENZIE KING ESTATE (JUNE TO SEPTEMBER)
___ Guide-interpreterDress in period costume, meet and interact
with visitors, provide guided tours of the garden.Requirements:
Must have own means of transportation; must possess
interpersonalcommunication skills (bilingualism and experience in
giving public presentations would be assets)
ACTIVITY 4.GATINEAU PARK (MID-AUGUST TO THE END OF OCTOBER)
___ Foot patrol
___ Mountain bike patrol
Requirements: Must have taken a first aid course; must be
bilingual; must be at least 18 yearsof age.
ACTIVITY 5.NEWSLETTER
___ Write articles for the volunteer newsletter. ___ Reporter
(NEW!)
COMMENTS
SECTION 4CONTACT USPlease complete and return by mail or
fax:Mail: National Capital Commission
Volunteer Centre20240 Elgin StreetOttawa ON K1P 1C7
Fax: 613-239-5133
For current information on volunteer positions, visit our
website,call us or send us an email.Telephone:
613-239-5373Email:[email protected]:www.canadascapital.gc.ca/volunteer
Privacy StatementThe personal information that you provide will
only be used by the NCC to select and contact volunteers for
suitable placement in support of NCC projects, events and otherNCC
activities. The information is protected under the Privacy Act. The
information will be retained in the files of the NCC under the
standard program records Informationand Orientation" (Record
Number: CECM-M400), "Volunteer Data Bank" (Specific Bank Number:
PPU 070). You have the right to review and correct information
aboutyourself and can be assured that it will not be used for
unauthorized purposes.
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mailto:[email protected]://www.canadascapital.gc.ca/volunteerhttp://www.canadascapital.gc.ca/volunteermailto:[email protected]
