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This information will be kept completely confidential

Your Name (required)

Preferred Name if different (required)

Your Age. Please select one.

Youth19-3536-55Over 55Retired

Your address:

Telephone Contacts:

Your Email (required)

Emergency Contact Person and Phone Number:

All volunteers with the Warmland Restorative Justice Society are required to have an annual Criminal Record Check. When your CRC is completed, are you willing to have a confidential discussion regarding the results?

YesNo

There is currently no charge for a standard Criminal Record Check for a volunteer with the Warmland Restorative Justice Society. A letter from the society must be attached to your Criminal Record Check application. Please be prepared with 2 pieces of photo identification when you attend the front counter of the RCMP detachment to complete the application

We require two personal references.

Reference 1 Name:
Address:
Phone:

Reference 2 Name:
Address:
Phone:

I consent to having Warmland Restorative Justice Society contact the references I have provided and agree to participate in an interview.
Selecting "Yes" will be the equivalent of your signature.
YesNo

If you have any questions about this form, please email the Society's Board of Directors at warmlandrjs@gmail.com