Auxiliary Volunteer Application

This application is for those wishing to support their community only in significant emergencies and to take occasional trainingaux volunteer zones

Which zone that you live in
Zone 1
Zone 2
Zone 3
Zone 4
Zone 5
Zone 6
Zone 7
Other Phone is
Home
Work
BC Driver's Licence
Yes
No
Do you have reliable personal transportation?
Yes
No
English Comprehension
Speak
Write
Read
Other Language (1) Comprehension
Read
Speak
Write
Other Language (1) Translation
Yes
No
Other Language (2) Comprehension
Speak
Read
Write
Other Language (2) Translation
Yes
No
Other Language (3) Comprehension
Read
Write
Speak
Other Language (3) Translation
Yes
No
Emergency Information
Other Phone is
Home
Work
CONFIDENTIALITY

By checking boxes and signing this form, you are agreeing to the terms and conditions defined below
I acknowledge and confirm that as a volunteer, I may acquire confidential information which may contain personal information, and that such information will remain in the strictest confidence, that individuals’ personal information is protected from unauthorized disclosure by the Freedom of Information and Protection of Privacy Act, and that unauthorized disclosure of individuals’ personal information is an offence under that Act. The unauthorized disclosure of such information to any unauthorized person, including making copies of any documents or records which contain or are derived from such information, is forbidden and is grounds for immediate dismissal and potential prosecution.
I agree to not discuss the details of my volunteer work, present or past with any representative of the media or any unauthorized person, or publicize any of the confidential aspects of my position by any medium of communication unless specifically given instruction to do so by my direct supervisor and/or a NSEM staff person. I agree to direct all enquiries from the media to the designated NSEM staff member or authorized agency.
DISMISSAL & TERMINATING THE VOLUNTEER RELATIONSHIP

By checking boxes and signing this form, you are agreeing to the terms and conditions defined below
I understand that I am viewed by the public as an agent of NSEM, the three North Shore municipalities and Emergency Management BC (EMBC) and that if I act in a manner that is considered unsatisfactory or unbecoming, that this will be addressed by NSEM through the following disciplinary process up to an including dismissal.
I agree that I will provide written notice to NSEM when I wish to terminate my volunteer relationship.
On terminating my volunteer relationship with NSEM, I will return any issued equipment, keys, uniform and my EMBC identification card within 2 weeks of termination or as agreed upon with NSEM staff.
FREEDOM OF INFORMATION AND PROTECTION OF PRIVACY ACT NOTICE

By checking boxes and signing this form, you are agreeing to the terms and conditions defined below
Personal information collected on the NSEM Volunteer Application Form is collected under the Freedom of Information and Protection of Privacy Act section 26(c) and will be used for the purpose of the NSEM volunteer program. If you have any questions about the collection and use of this information please contact North Shore Emergency Management at 778-338-6300.
DISCLAIMER

By checking boxes and signing this form, you are agreeing to the terms and conditions defined below
I certify that all answers given by me on this volunteer application form are true, correct and complete to the best of my knowledge. NSEM has my consent to contact the references I have identified in this application. I have contacted the above references to confirm their contact information and their willingness to provide a reference for me. I have read the “Responsibilities of a Volunteer” statements and understand that breaching of any of these responsibilities would be cause for termination of my volunteer position. I agree to comply with NSEM policies, rules and regulations. I acknowledge that NSEM is under no obligation to accept me as a volunteer.