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Community Service Order Intake
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Community Service Order Intake
Adult/Youth Community Service Order Intake Form
Fine Type
*
YCSO (Youth Community Service Order)
ACSO (Adult Community Service Order)
EJS (Extra Judicial Sanctions)
Contact Info
Name
*
First
Last
Email
*
Enter Email
Confirm Email
Primary Phone
*
Alternate Phone
Address
*
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Probation Officer/Youth Worker
*
First
Last
Upload Notice of Community Service Order Hours
Upload the Notice of Community Service Order Hours document you received from your probation officer. Skip this field if you do not have a digital copy of this document.
Accepted File Types:
PDF, JPG/JPEG, PNG
Max files:
3
Drop files here or
Select files
Accepted file types: jpg, jpeg, pdf, png, Max. file size: 5 MB, Max. files: 3.
Applicant Details
Date of Birth
*
DD slash MM slash YYYY
Age
*
Please enter a number from
12
to
99
.
Gender
Select...
Male
Female
Prefer not to say
Other
Gender Identity
Ethnicity
Metis
Status
Non-Status
Caucasian
Employment Status
Employed
Unemployed
Drug Court
Student
Which city would you like to volunteer in?
*
Select...
Regina
Saskatoon
Moose Jaw
Current Placement Opportunities in Saskatoon
Salvation Army Cross Roads - soup kitchen.
Mission Thrift store - Open Tuesday to Friday from 10am to 4pm.
Westside Community Centre - open Tuesdays from 9am to Noon. (Sorting donations)
Organizations of Interest (Saskatoon)
*
Use the field below to indicate which partner organizations you would be most interested in working with. Select all that apply.
Click here
to learn more about our partners.
Salvation Army Cross Roads
Mission Thrift Store
Westside Community Centre
Organizations of Interest (Regina)
*
Use the field below to indicate which partner organizations you would be most interested in working with. Select all that apply.
Click here
to learn more about our partners.
Ahmadiyya Muslim Jamma’at Mosque
Al Baaqi Foundation
All Nations Hope Network
Darul Falah Islamic Center
Ehrlo Sports Venture
Gateway Church
Habitat for Humanity Restore
Indigenous Christian Fellowship
Islamic Association of SK - Regina
Rahmah Centre
Rainbow Youth Centre (YOUTH ONLY)
REACH - Regina Education Action on Child Hunger Inc.
Regina Sikh Temple
Regina Victory Church
St. Anthony's Church
The Comeback Society
The Gathering Place
YWCA Regina
Organizations of Interest (Moose Jaw)
*
Use the field below to indicate which partner organizations you would be most interested in working with. Select all that apply.
Click here
to learn more about our partners.
Canadian Mental Health Association
Habitat for Humanity Moose Jaw
Hunger in Moose Jaw
Joe's Place
John Howard Society (Moose Jaw Branch)
Lyle Helland Memorial Field
Moose Jaw & District Senior Citizens Association
Moose Jaw Pride
Riverside Mission
Salvation Army Moose Jaw
Victory Church of Moose Jaw
Are you currently an employee of the work placement organisation(s) chosen?
*
Yes
No
Additional Notes
Health Concerns or Conditions:
Comments/Contact Notes:
COVID-19 Vaccination Status
*
Are you fully vaccinated for the COVID-19 virus? Many placement agencies require you to be fully vaccinated in order to work with them.
Yes, I have received both doses of my vaccination.
No, I am not fully vaccinated.
Prefer not to say.
Privacy Consent
*
I understand and agree to the
privacy policy
.
WCB Consent
*
I understand and agree to the
work-based programs consent and agreement
.
Phone
This field is for validation purposes and should be left unchanged.
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