Backup Hub Responder Application Form Applicant InformationName* First Last Email* Phone*Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Education, training, or work experience that may relate to crisis intervention work:*Present occupation and employer:*Are you 18 years of age or older?* Yes No Do you have access to a laptop/computer that runs Windows 10 / macOS 10.15 or newer?* Yes No Do you have access to secure password protected internet with 50-100mbp Download/Upload speeds?* Yes No Click here to 'run speed test'Background and Experience1. Why do you want to be a backup hub responder? What do you hope to gain personally from this experience?* 2. In addition to good listening, what skills or personal qualities do you possess that could be applicable to crisis intervention work?* 3. Describe a situation where you needed help. Explain what it was like, and what you feel you learned from this situation. How might this experience affect your work on the crisis lines?* 4. Are there any issues, topics or views that you might have trouble being objective about?* 5. Have you ever known anyone closely who was suicidal?* 6. How do you currently handle personal issues or problems that arise? (Please be specific.)* 7. What other commitments (personal or professional) do you have at this time?* 8. Are there any time periods that you know may interfere with you fulfilling your training commitment or your shift commitment (including overnight)?* Emergency ContactName* First Last Email* Phone*Relationship* ReferencesName* First Last Company* Email* Phone*Relationship* Name* First Last Company* Email* Phone*Relationship* Name* First Last Company* Email* Phone*Relationship* Previous ExperienceHave you previously applied to a crisis or distress centre for a position as a crisis responder? If so, when?* How did you hear about this opportunity?* Consent* I certify that my answers are true and complete to the best of my knowledge.If this application leads to an offer as a CSC remote volunteer responder, I understand that false or misleading information in my application or interview may result in my release.CAPTCHA If you or someone you know is in immediate danger, call 9-1-1
