Become A Volunteer - Kingston Community Health Centres

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Enter Email Confirm Email

Age Range

Special interests, skills, or hobbies(Required)

Languages spoken

English

French

Other

English Fluency

English Verbal Fluency(Required)

English Written Fluency(Required)

French Fluency

French Verbal Fluency(Required)

French Written Fluency(Required)

Other Language Fluency

Which Language?(Required)

Verbal Fluency(Required)

Written Fluency(Required)

What is your availability?

What are the most convenient days and times for you to volunteer?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Which KCHC programs interest you the most?

What wold be your top 3 choices in order?

Choice 1

Choice 2

Choice 3

Emergency Contact Information

Name

First Last

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Vulnerable Sector Criminal Record Check (CPIC)

Due to the nature and commitment of our volunteer work at KCHC, we require you to complete some additional verification steps. This is to ensure each volunteer can support the work of KCHC, and align with our core ethics, and values.

We require all volunteers 18+ years of age to complete a Vulnerable Sector CPIC before they begin in their volunteer role.

You can go in person to the police station to apply, upfront cost is $40.00 -$51.00.
You can apply online with a credit card, follow this link for Kingston – https://policechecks.kpf.ca/

Please do not complete a CPIC until you are approved to do so by our KCHC Human Resource Department. Those approved to complete their CPIC will be eligible for full reimbursement once the original receipt and Hard Copy or certified digital copy is provided. It is a requirement for reimbursement that our organization is listed on your Vulnerable Sector Criminal Record Check (CPIC). If you do not require reimbursement, we will accept an original or certified copy of your Vulnerable CPIC that has been issued in the last 6 months. Certified copies can be obtained by the Issuing office (Police or OPP).

Please select the applicable options

Once approved I will be requesting my Vulnerable CPIC and will require reimbursement

I have an original or certified copy that has been issued in the last 6 months and I do not require reimbursement.

I will be obtaining my Vulnerable CPIC online or from my local OPP station and require Volunteer Reference letter.

If you are applying to be a volunteer driver, once approved by our HR team you will need to supply:

Copy of a valid Driver’s Licence (front and back)
Personal Auto Insurance (pink slip)
3- year uncertified Driver’s License Abstract (Keep your receipt we will reimburse you)

Resume

We would love to learn more about you and to understand how your skills will elevate our volunteer programs! If possible, please attach your resume.

I have attached my resume

I have NOT attached my resume

Vounteer References

Please include two references. Each reference must be a previous or current employer, volunteer supervisor or teacher. Volunteers under the age of 18 may supply 2 letters of reference from the above identified individuals or a community professional such as a physician, lawyer, or police official in place of a reference contact.

1st Reference

Name

First Last

Relationship

Phone

2nd Reference

Name

First Last

Relationship

Phone

If you are unable to provide a reference, or they do not meet our criteria, please provide a reason.

This will allow KCHC to look at any possible solutions.

I attest:

By completing and submitting this form, I confirm that the above statements and included information are true, and I understand that any untrue or misleading information on this form or my resume may disqualify me from volunteer service with Kingston Community Health Centres. I agree that Kingston Community Health Centres may check references with the individuals provided.