St. Stephen's Conflict Resolution Service: Mediator Application Form

Volunteer Mediator Application Form


Personal Information
First Name	Last Name


Day Phone Number	Evening Phone Number
-	-

Email	Fax Number
	-

Home Address	Town/City


Province/Territory	Postal Code


Gender	Age
Female Male

First Language	Other Languages


Ethnicity*	Country of Birth*

* We welcome applicants from all diverse ethno-cultural communities in an effort to improve our ability to better serve the multi-ethnic population of Toronto. However, it is your right under the Ontario Human Rights Code not to answer these question, so consider them optional.

Current or recent employment
Company Name	Is this a current position?
	Yes No

Street Address	Town/City


Responsibilities


Reference 1
First Name	Last Name


Phone Number	Email Address
-

Relationship


Reference 2
First Name	Last Name


Phone Number	Email Address
-

Relationship


Please give us an idea about your general availabilty.
Weekdays Weekday evenings Weekends

Please attach your résumé in MS Word, .txt or .pdf format


Information and experience
How did you find out about St. Stephen's Conflict Resolution Service?


Why do you want to be a volunteer mediator and what do you expect to gain from your experience at St. Stephen's Conflict Resolution Service?


Please outline present and previous volunteer work.


What can you describe in your experience or training that gives you a level of comfort and knowledge in dealing with poverty issues, intercultural and interclass settings?


Is there anything else you would like us to know about you?