This is your Application for a Distress Line Listener.  This form is CONFIDENTIAL WHEN COMPLETED.  Thank you for your interest in applying.

Name	*
email address	*
Preferred Name	*
Address	*
City	*	Postal Code*
Home Phone	*	Cell Phone
Birthday (dd/mm)	*
Languages (spoken and/or written)	*
Education	*
Training Courses	*
Occupation	*
How did you hear about us?	*
Why do you want to volunteer here?	*
Have you done volunteer work before?	*	yes No
If yes, Please describe (where, what you did)	*
References (Please provide 2: names/phone numbers). Please use present or past employers, Volunteer Supervisors, Teachers and/or Instructors	*
Please have two past or present employers, volunteer supervisors, teachers and/or instructors complete the reference request forms. Family members and friends will not be accepted as suitable referees. By completing this Application Form and clicking the submit button below, I am giving Distress Centre Wellington- Dufferin permission to use the information supplied above for the sole purpose of assessing my suitability as a volunteer with Distress Centre Wellington-Dufferin.
Please type your name.	*
Please enter today's date.	*