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Volunteer Resource Application

(Fields marked with a * are mandatory.)

Enter your information in the form below:

Title:
Miss Ms. Mrs. Mr.

Application Type:*
Adult Student

Name (First and Last):*

Telephone Home:*

Birthdate (confidential):*

Telephone Work:

Street:*

City:*

Province:*

Postal Code:*

Email Address:*



Emergency Contact:*

Telephone Home:*

Relationship:*

Telephone Work:

Which of our hospitals would you like to volunteer at? *

Markdale
Meaford
Lion's Head
Owen Sound
Southampton
Wiarton



Languages Spoken * English French
Other, please specify:

I am currently *:
employed full-time or part-time
at: position:
past employment: position:
seeking employment
a homemaker
a student full-time at:
a student part-time at:
retired from career as:
other, please specify:

Skills *

Clerical
Computer
Sewing
Knitting
Business
People
Sales
Customer Service

Other skills:

Previous Volunteer Experience *

Health Problems/Limitations

I will commit to: *
6 Months 1 Year +

I take extended vacations
Summer Winter

I take normal vacations
Summer Winter

I want to volunteer at the hospital to: * (where applicable)

Help others
Meet people
Learn new skills
Explore career opportunities
Keep busy
Educational requirements
Personal Satisfaction
Show appreciation for help received

Other:

I am able to volunteer: * (check where applicable)

Time

Mon.

Tues.

Wed.

Thurs.

Fri.

Sat.

Sun.

Morning

Afternoon

Evening

I heard about volunteering at the hospital from: * (where applicable)

Hospital staff
The library
Hospital volunteer
School
Visiting hospital
Local newspaper

Other:

Have you ever been convicted of a criminal offense for which you have not received a pardon?* Yes No

If yes, please explain:

References:

I hereby authorize Volunteer Resources to contact, in strict confidence, the following references. Please provide 2 professional references (do not use relatives)

Reference #1

Name:*

Telephone Home:*

Relationship:*

Street: *

City:*

Province: *

Postal Code:*

Email:

Reference #2

Name:*

Telephone Home:*

Relationship:*

Street: *

City:*

Province: *

Postal Code:*

Email:

Student Volunteers:

Volunteer opportunities for full or part time students are available in either our school year program (October – May) or summer program (May – August). Due to limited placement opportunities during the school year, preference is given to students in grade 11 and up. Most student volunteer opportunities require a minimum commitment of 2-4 hours per week.

Commitment / Consent:

I agree to comply with Volunteer Resources’ requirements and policies as outlined in the Orientation Manual and my Position Description.

  • I will be punctual and carry out my duties to the best of my abilities.
  • I will notify my Convenor/Staff Liaison of any necessary absence from my Service as far in advance as possible.
  • I will return my badge and uniform when I am no longer a Volunteer.
  • I am willing to have my name and telephone number shared with fellow volunteers, as required.
  • I am willing to adhere to my commitment.

NOTE: All volunteer information is held in strict confidence and will be used only to match an individual to a suitable position, in the collection of statistical information or in trending studies.

I Agree *




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