All information provided in this form is kept confidential.

I am aware that training and volunteering for Option A take place in Nanaimo. Yes

I have carefully read the training schedule and have noted its training dates. Yes

I have read and understood that from Weeks 1 to 5 of the training schedule, online meetings via Zoom will take place on Wednesdays, from 5:00 pm to 8:00 pm Pacific. Yes

I am aware I will be undertaking the training modules described in the training schedule online via Trainual. Yes

I have read and understood Vancouver Island Crisis Society's Communicable Disease Prevention Recommendations for Volunteer Trainees and Trainers in our training facilities. Yes

Select volunteer training and opportunity (review 20-hour monthly commitments):

1. Option A – Volunteer Training for Crisis Line Responders providing support from our Crisis Centre, with remote service options2. Option B – Volunteer Training for Remote Crisis Line Responders answering Vancouver Island Crisis Chat and Crisis Text only (available to Vancouver Islanders only from 6:00 pm to 10:00 pm Pacific, seven nights a week)3. Option C – Volunteer Training for Crisis Line Responders providing support remotely only

If you have selected Option B or Option C, do you meet the standard technological requirements to volunteer remotely?

1. Yes2. No3. N/A

Your Name

Address

City, Province, Postal Code

Telephone (Home)

Telephone (Mobile)

Telephone (Work)

Email Address

Education, training, or work experience that may relate to crisis intervention work:

Present occupation and employer:

Please answer each of the following questions as fully as possible.

1. Why do you want to work at the Crisis Society and what do you hope to gain personally from this experience?

2. In addition to good listening, what skills or personal qualities do you possess that could be applicable to crisis intervention work?

3. Describe a situation where you helped someone.

4. Describe a situation where you needed help. Explain what it was like, and what you feel you learned from this situation. How might this experience affect your work on the crisis lines?

5. Are there any issues, topics or views that you might have trouble being objective about?

6. Have you ever known anyone closely who was suicidal? What was their relationship to you?

7. What stresses are you currently experiencing? (Please be specific.)

8. Do you have any medical conditions of which we should be aware? (Examples: depression, hearing impairment, etc.)

9. How do you currently handle personal issues or problems that arise? (Please be specific.)

10. Have you ever experienced any abuse either personally or professionally? If yes, how have you dealt with those issues?

11. What is the one thing about yourself you would most like to improve?

12. What other commitments (personal or professional) do you have at this time?

13. Are there any time periods that you know of that may interfere with you fulfilling your training commitment or your volunteer commitment (including overnight)?

14. Has it been at least at least one year since you have experienced a major life event such as death, divorce, addiction, or mental illness?
YesNo
If it has been less than one year, please let us know what transpired and how you are currently feeling.

15. Has it been at least at least one year since you reached out to a Crisis Line to obtain support for yourself?
YesNo
If it has been less than one year, please expand on what was your concern and how you are currently coping.

16. Has it been at least at least two years since you experienced a personal suicide attempt or the suicide death of a loved one?
YesNo
If it has been less than two years, please let us know how you are coping since the attempt occurred or since you experienced the loss of your loved one.

Person to contact in case of emergency:

Name

Relationship

Phone

Please provide three non-family references, including one employer:

1. Name

Relationship

Phone

2. Name

Relationship

Phone

3. Name

Relationship

Phone

Have you previously applied at the Crisis Society? If so, when?

How did you hear about the Crisis Society?

$100 Volunteer Fee Payment

Please select your preferred payment option:

1. e-Transfer via email at etransfer(at)vicrisis.ca (receipt provided by registrant's banking institution)2. PayPal Shopping Cart at https://www.vicrisis.ca/shop-vics/3. Credit Card by calling VICS at 1-877-753-2495 (office is open Monday to Thursday, from 9 to 12 and 1 to 4)4. Cheque made out to Vancouver Island Crisis Society, which can be mailed to PO Box 1118, Nanaimo, BC V9R 6E75. Cash, usually provided directly to a Crisis Society Trainer

Privacy Act and the Protection of Information: All information in this application is kept confidential under the Privacy Act. Applications are stored in a locked filing cabinet for the duration of an individual's volunteer experience with the Crisis Society and are shredded within a year from the time they leave the Society. The Crisis Society does keep basic statistics such as an individual's name, address, and phone number. If you do not wish us to keep this information, please let us know and we will delete your name from our database.