Backup Hub Responder Application Form

Applicant Information

Name*

First Last

Email*

Phone*

Address*

Street Address Address Line 2 City 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 Experience

1. 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 Contact

Name*

First Last

Email*

Phone*

Relationship*

References

Name*

First Last

Company*

Email*

Phone*

Relationship*

Name*

First Last

Company*

Email*

Phone*

Relationship*

Name*

First Last

Company*

Email*

Phone*

Relationship*

Previous Experience

Have 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.

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Applicant Information

Background and Experience

Emergency Contact

References

Previous Experience

If you or someone you know is in immediate danger, call 9-1-1

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