Screening Policy Application form


Individuals who want to work or volunteer for the Canadian Blind Sports Association (CBSA) or one of its participating members must complete this application form. It must be completed for the position the individual is seeking, however, should they apply for a new work or volunteer position within CBSA or one of its participating members, a new Application Form will have to be submitted. For the other two required forms please see Appendices C and D.

NAME: (First, Middle, Last) ________________________________________________________________

CURRENT PERMANENT ADDRESS: (Street, City, Province, Postal Code)


DATE OF BIRTH: (Month/Day/Year) ____________
GENDER IDENTITY: ________________

EMAIL: _______________¬¬¬¬_____ PHONE: ______________________

POSITION SOUGHT: ______________________________________________

By signing this document below, I agree to adhere to the policies and procedures of the Organization and/or the Participating Member (as applicable), including but not limited to the Code of Conduct and Ethics, Conflict of Interest Policy, Privacy Policy, and Screening Policy. Policies are located at the following link: [insert link]

I recognize that I must pass certain screening requirements depending on the position sought, as outlined in the Screening Policy, and that the Screening Committee will determine my eligibility to volunteer or work in the position.

NAME (print): ___________________ DATE: _________________

SIGNATURE: ___________________