Community Council Declaration of Interest

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Community Council Declaration of Interest

Special Olympics Ontario – Declaration of Interest

Application for Community Council

Name: _________________________________________________________________

Address: _______________________________________________________________

Email: __________________________________________________________________

Telephone: (Home) ____________________________ (Work) _________________

Prefer to be contacted at: Home: _______________ Work: __________________

Best time to call: ___________________

Position Applying for: ___________________________________________________

Have you ever been involved with Special Olympics Ontario? Yes ______ No_____

If yes, please list positions held: ____________________________________________

Please outline your other volunteer/work experiences relevant to the position applied for:

Organization Position Held Years of Service Duties

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Briefly describe any other experiences/expertise you have:

Administration: __________________________________________________________

Leadership: _____________________________________________________________

Event Management: _____________________________________________________

Sport Specific: __________________________________________________________

Please explain why you would like to be part of the Special Olympics Ontario Team:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Would you be interested in any other positions within the organization? Administration (Chairperson, Treasurer, Volunteer Co-ordinator, Secretary) Sport (Head Coach, Assistant Coach, Manager)

List name and phone number of two non family personal references:

Name: ______________________________________ Phone: _________________

PLEASE READ BEFORE SIGNING:

I understand that:

The information that I have provided may be verified, and I give permission to Special Olympics to make inquiries of others which may include a criminal background check to determine my suitability to act as a Special Olympics volunteer.
In the course of volunteering for Special Olympics, I may be dealing with confidential information and I agree to keep such information in the strictest confidence
The relationship between Special Olympics and volunteer is an “at will” arrangement and it may be terminated at any time without cause by either the volunteer or Special Olympics

I affirm that I have read the above and that the information that I have given is true and complete.

Signed: _______________________________________ Date: _________________