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
Reference 1  
First Name Last Name
Phone Number Email Address
Reference 2  
First Name Last Name
Phone Number Email Address
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?

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