Volunteer Driver Application Form

Transcona Council for Seniors

Colleen Tackaberry

Seniors Resource Coordinator

204-222-9879

1. Personal Information

Mr.

Mrs.

Ms.

2. Best Time to Contact: 

Morning

Afternoon

Evening

3. Vehicle:

Answering machine:

Yes

No

Year:

Is your vehicle a van?

Yes

No

Is your vehicle a mini-van?

Yes

No

4. Have you ever been involved in a car accident in the last five years?

Yes

No

5. Please indicate the days of the and the hours you are available:

Monday

Morning

Mid-Day

Afternoon

Tuesday

Wednesday

Thursday

Friday

How many shifts would you like per week?

6. How long would you like your commitment to be? (Please check one)

6 Months

1 Year

Ongoing

Other

7. Date Submitted: