Crisis Line Volunteer Application

Please fill out and submit the application form below:

Application form to apply for a crisis line position.

Name: * Required
First Last
Address: * Required
Street Address Address Line 2 City Province Postal Code
Phone Number: * Required
Email:
Birthdate: - must be mm/dd/yyyy format * Required
Date Format: MM slash DD slash YYYY
Tell us a bit about yourself: * Required
Present Occupation/Employer:

1. Why do you want to work on the Crisis Line? * Required
2. What do you hope to gain personally from this experience? * Required
3. Are there any issues, topics or views that you might have trouble being objective about? * Required
4. What stresses are you currently experiencing? (Please be specific) * Required
5. Do you have any mental health concerns that we should be aware of? * Required
(i. e. depression, stress, etc.)
6. How do you currently handle personal issues or problems that arise? (please be specific) * Required
7a. Do you have any experience that may support/interfere with working on the crisis line? * Required
7b. If yes, please describe:
8. How did you learn about the volunteer Crisis Intervention Worker position? * Required
- Newspaper
- Online
- Radio
- Poster/Flyer
- Employer
- School
- Church
- Friend
- Other
9a. Give an example of a situation where you supported someone: * Required
9b. In that situation, what did you do that helped them the most?
Please list two professional references (i.e no family members) *Your references must be aware that we will be contacting them*
1. Name: * Required
First Last
Relationship to you: * Required
Phone * Required
Email
Email
Preferred Contact Method * Required
2. Name: * Required
First Last
Relationship to you: * Required
Phone * Required
Email
Preferred Contact Method * Required
Person to contact in case of emergency: * Required
First Last
Relationship to you: * Required
Phone * Required
I am 19 years of age or older. * Required

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