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ST. JOHN CANADA INSTRUCTIONS 2-9-2ap6
PLEASE PRINT.
(number & street) (city) (Province) (postal code)
PLEASE ANSWER THE FOLLOWING TO THE BEST OF YOUR KNOWLEDGE.
1. How well do you know the applicant?
2. How long have you known the applicant? ______________________________________3. In what capacity have you known the applicant? What is your relationship to this person? (Friend? Service Club? Work? Please specify.) __________________________________________________________________________ 4. Below, please check ONLY those characteristics you have had the opportunity to observe.
5. Please check any of the following personality traits which best describe the applicant: þ
6. What are the applicants personal strengths? _______________________________________________________________ ______________________________________________ 7. What are the applicants personal limitations? _______________________________________________________________ ______________________________________________ 8. How well does the applicant work with others?
Comments__________________________________________ 9. How effectively does the applicant work independently?
Comments__________________________________________ 10. Being a St. John Ambulance Brigade volunteer involves working with, and in some positions, providing first aid treatment for anyone in need, regardless of any other consideration except that of personal safety (i.e. violence or civil disturbance). This includes people of all ages from young children to senior citizens. It also includes no regard for their creed, colour, ethnic origin, gender, social status, or disability. Do you know of any reason, limitation, or situation that makes you feel the applicant would have difficulty providing assistance to a total stranger? _______________________________________________ ________________________________________________
11. Some positions require approximately forty hours of initial training, regular weekly attendance at meetings (about two hours per week) and an average of five additional hours of volunteer work per month. Do you feel the applicant will have sufficient time to make a meaningful contribution to St. John Ambulance without sacrificing their other obligations? YES / NO (Please give reason for your answer) ______________________________________________ ______________________________________________ 11. Would you choose this applicant to help YOU or your child if the need arose? (Why or why not?) ______________________________________________ ______________________________________________ 12. Would you recommend this applicant as a St. John Ambulance Brigade volunteer? (Why or why not?) ______________________________________________ ______________________________________________
Signature: _______________________________ Date: _________________________ Position/Occupation: _____________________________________________________ Home phone # ______________________ Work phone # ______________________
THANK YOU FOR YOUR ASSISTANCE.
PLEASE RETURN THE COMPLETED FORM DIRECTLY TO ST. JOHN AMBULANCE.
(Place your District address, fax # and contact name here) |
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Send mail to Copyright © 1997 St. John Ambulance Cadets of Ontario Last modified: August 17, 1998 |