Advocate Application Form

2. Volunteer Advocate Application
   HINTON VICTIM SUPPORT SERVICES 111 Civic Centre Road Hinton, AB T7V 1T8

   HINTON VICTIM SUPPORT SERVICES 111 Civic Centre Road Hinton, AB T7V 1T8

4. After successful completion of the standardized volunteer training and evaluation, and other requirements, including security clearance by the appropriate police service, potential volunteers may be qualified as a Victim Services Advocate with your local Victim Services Unit (VSU). Victim Services Units (VSUs) in Alberta are police-based programs that may be administered by a Board of Directors of a non-profit society or a municipal police service. VSUs provide support to victims and include staff (generally a Program Coordinator and may include additional staff members) and volunteer Advocates. Once qualified, the volunteer Advocate will respond immediately to referrals to provide short term emotional support and practical assistance to victims of crime or tragic circumstance. The volunteer will ensure that appropriate options and/or referrals for longer term assistance are provided to the victim.

   After successful completion of the standardized volunteer training and evaluation, and other requirements, including security clearance by the appropriate police service, potential volunteers may be qualified as a Victim Services Advocate with your local Victim Services Unit (VSU). Victim Services Units (VSUs) in Alberta are police-based programs that may be administered by a Board of Directors of a non-profit society or a municipal police service. VSUs provide support to victims and include staff (generally a Program Coordinator and may include additional staff members) and volunteer Advocates. Once qualified, the volunteer Advocate will respond immediately to referrals to provide short term emotional support and practical assistance to victims of crime or tragic circumstance. The volunteer will ensure that appropriate options and/or referrals for longer term assistance are provided to the victim.

5. 

9. Personal Information

11. First Name*

12. Middle Name(s)

13. Last Name*

15. Maiden Name / or Previously Used Surnames

17. Address1*

19. Address2

21. City*

22. Province

23. Postal Code

25. Email Address*

27. Home/Main Phone*

28. Alternate Phone:

30. Marital Status

32. Birth Date*

    month/day/year

33. Place of Birth*

35. How long have you resided in this area?*

37. Do you have a valid Alberta Driver’s License? *

    1. yes
    2. no

39. Operator Number:

41. Has your license ever been suspended or revoked? *

    1. yes
    2. no

42. Do you have a vehicle?

    1. yes
    2. no

44. Emergency Contact*

46. Have you ever been convicted of a criminal offence?*

    1. yes
    2. no

47. If yes, please explain:

49. Education:*

    (check all that apply)

    1. Junior High School
    2. High School

    1. Post-Secondary
    2. Specialized Courses / Training
51. How did you learn about Victim Services:*

    (check all that apply)

    1. RCMP Member
    2. Public Display
    3. Website

    1. Newspaper
    2. Victim Services Volunteer
    3. Other
53. List all languages you speak, read, and write:

55. Do you know any RCMP Members or Victim Services Volunteers?

    If yes, please list their names

57. Are you legally entitled to work in Canada?

    1. yes
    2. no

61. References

63. Reference #1 Name*

64. Relationship*

66. Phone Number*

67. How long have you known this person*

69. Reference #2 Name

70. Relationship

72. Phone Number

73. How long have you known this person

75. Reference #3 Name

76. Relationship

78. Phone Number

79. How long have you known this person

81. List the organizations and associations you are currently involved with (if any).*

83. Explain your reasons for applying to Hinton Victim Support Services. *

    What do you hope to gain from this experience?

85. Are you willing to volunteer with Victim Services in a capacity other than an advocate role? *

    1. yes
    2. no

    (Fundraising, Community Events, etc)

89. Statement
    I, the individual named above, hereby give permission to the Office of Hinton Victim Support Services to obtain all information necessary to qualify me as a volunteer advocate of the Hinton VSU Program, including an RCMP Criminal Record Check and Vulnerable Sector Check. ATTENTION: I acknowledge any false information given on this application will be grounds for denial of acceptance or immediate dismissal.

    I, the individual named above, hereby give permission to the Office of Hinton Victim Support Services to obtain all information necessary to qualify me as a volunteer advocate of the Hinton VSU Program, including an RCMP Criminal Record Check and Vulnerable Sector Check. ATTENTION: I acknowledge any false information given on this application will be grounds for denial of acceptance or immediate dismissal.

91. Confirmation*

    1. Yes

    1. No

    Do you understand the above statement?

93. Signature*

    If you understand the above statement and certify the information provided to be correct to the best of your knowledge, please re-enter your full name as confirmation

Leave This Blank:


95. 1. Receive an email copy of this form.
96. Email address

    This field is not part of the form submission.

97. Submit

* indicates a required field