By checking this box, I verify that I am 18 years of age or older and thereby, I am eligible to apply for volunteer work with Distress Centre Durham.

Below is our online volunteer profile application form. If you would rather submit your application by mail or fax please click here, otherwise please fill out the form below and you will be directed to the second part of the application.

Full Name:
Address:

City/Town:		Postal Code:
Phone Home:		Phone Business:

Email Address:

How did you hear about our organization?	unselected newspaper brochure phone book speaker website other
Please be specific...........

What aspects of volunteer work do you wish to contribute? {1 or more}

Helpline Worker

Call Out Worker

Placement Student

If you indicated any of the positions, what appeals to you about them?

What qualifications, skills or experiences can you share in the above areas?

What is your present occupation, or what previous jobs have you held?

What organizations have you joined in the past? What was your role?

What special projects, with any of these organizations (or your job) have you been responsible for organizing, and which have been in addition to your normal role?

What do you think would be the best part about being a Distress Centre helpline volunteer and what do you think would be the worst part?

Educational Background:

unselected Secondary Post Secondary Returning to School

What qualities, outside of listening skills, do you possess which you feel would make you a good helpline worker volunteer?

What other skills or strengths which you feel may be useful to our organization would you agree to share?

Have you ever used Distress Centre Durham Helpline?	unselected yes no
Are you willing to get a Police Records Check?	unselected yes no
Are you involved with Counseling/Therapy currently?	unselected yes no
When are you available?	unselected Morning{8am-12pm} Afternoon{12pm-4pm} Supper{4pm-8pm} Evenings{8pm-12midnight} Overnight{12midnight-8am}
Please indicate, honestly, if there is someone with whom you would feel uncomfortable talking:	unselected No Males Females Youth Seniors Other
If you selected one of the above, please indicate reason:
Is there a situation that could trigger a negative reaction from you?	unselected No Incest Abortion Homosexuality Mental Illness Abuse{wife/child/sexual/verbal/etc} Substance Abuse{alcohol/drugs} Sexual Fantasizer Other
If you selected other, please state.....
Are you prepared to attend a 17 hour training workshop {2x8.5hour sessions} before you begin volunteering?	unselected Yes No
Are you willing to participate in working {over and above the basic training workshops} to develop your active listening and crisis/suicide intervention skills?	unselected Yes No

We must ask for a Firm commitment as a volunteer with the Centre after successful completion of our training. Our policy states that we cannot provide reference letters {for employment, educational studies, etc,} until volunteers have completed their agreed-upon commitment. Are you prepared to sign a contract committing to 15 hours per month {including one over-night shift}, answering calls and recording call reports and volunteering for a duration of one year {renewable}?

unselected Yes No Would like to Discuss

Please Include 2 references: 1 personal and 1 professional

Please note we will be contacting references by mail. Please ensure addresses are complete {i.e. with apartment numbers and postal codes) Thank you.

Professional Reference:

Full Name:
Address:

City/Town:		Postal Code:
Phone Home:		Phone Business:

Personal Reference:

Full Name:
Address:

City/Town:		Postal Code:
Phone Home:		Phone Business:

For security reference, please type your last name and postal code. {i.e SmithA1B2CD}