This page is currently under review by Special Olympics Ontario
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: _________________
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: _________________