Online Volunteer Application

Have You Volunteered With Operation Red Nose Before? *

YES, I am a RETURNING volunteer

NO, I am a NEW volunteer

Do You Require A Volunteer Recognition Certificate? *

YES

First Name *

Last Name *

Birth Date *

Sex

Male

Female

Non-binary

House # *

Street Name *

Street Suffix *

Street Direction

City *

Postal Code *

Phone Number *

Phone Type *

Add Another Number

2nd Phone Number *

2nd Phone Type *

Add Another Number

3rd Phone Number *

3rd Phone Type *

Email Address *

Which Organization Are You Representing? *

Community (None)

Corporate

Manta Swimming

Swimmer Name *

Company Name *

Do You Have A Drivers License? *

YES

YES, but NON MANITOBAN

Driver's License Number *

Format: **–**–**–******

Non MB Driver's License Number *

License Expiry *

Comfortable Driving Standard? *

YES

Do You Have License Restrictions? *

YES

Please Explain Your License Restriction(s) *

Primary (Photo) Identification: *

Primary (Photo) I.D must be one of the following:: Driver’s License; Passport; Permanent Resident Card; Aboriginal Status Card; Manitoba Public Insurance Identification Card

Secondary Identification: *

Secondary I.D must be one of the following:: Birth Certificate; Social Insurance Card – (SIN confirmation letters effective April 2014); Provincial Health Card; Citizenship Card; Firearms License; Immigration Papers; National Defense Card; Nexus Card; FAST CARD from Canada Border Services Agency

Criminal Offence(s) *

I HAVE NOT been convicted of a criminal offence in Canada or elsewhere or, if I have been convicted of a criminal offence, I have obtained a pardon.

I HAVE been convicted, in Canada or elsewhere, of one or more criminal offences.

Pending Charge(s) *

I AM NOT subject to any pending charges for a criminal offence in Canada or elsewhere.

I AM subject to one or more pending charges, in Canada or elsewhere, for one or more criminal offences.

Court Order(s) *

I AM NOT subject to any court order made against me in Canada or elsewhere.

I AM subject to one or more court orders made against me in Canada or elsewhere.

Offence/Charge/Order Description *

Date Of The Event *

Place Of The Event *

Your Signature *

Reset Signature

Signature is required.

Terms & Conditions *

I authorize Operation Red Nose (ORN) and any police service with jurisdiction over any or all parts of the province in which I reside to conduct a criminal record check to ensure that I meet the selection criteria set out by ORN that appear on the back of this form. However, only judicial antecedents that ORN deems to be incompatible with the volunteer’s assignment will be taken into account. If my assignment requires the driving of a road vehicle, I authorize ORN and any police force to check the validity of my driver’s licence. I also give my consent to the police force to forward the results of the background checks to ORN. A false declaration will result in the refusal of the application. Furthermore, between the time I submit this form and the time I participate as a volunteer, I will inform ORN of any new charge(s) against me relating to an offence and any conviction(s) in connection with such an offence. In accordance with the relevant legislation, ORN and its representative agree to protect the confidentiality of all information and data about the organization’s clients and volunteers. Any declaration form that has not been signed or that contains unanswered questions will be considered incomplete and returned to sender. I also agree to comply with the volunteer commitment set out on the back of this form, which I have read and understood. I certify that the information provided in this declaration is accurate and complete.

I Agree

I DO NOT Agree

YOU MUST AGREE TO THE TERMS & CONDITIONS IN ORDER TO SUBMIT YOUR APPLICATION

CALL (204) 947-6673

CALL (204) 947-6673

Operation Red Nose Online Volunteer Application

Thank you for your support!