Volunteer Application Form

Fields marked with * are required

Name *

Phone *

Email *

Mobile

Address *

Town *

Postal Code *

Gender

Male

Female

Are you volunteering as part of a program?

Yes

No

If yes, please specify program

Current Occupation

Employed

Student

Retired

Other

Employer / Other

Branch / Group

Delhi

Port Dover

Simcoe

Waterford

Emergency Contact Information

Family Doctor's Name *

Doctor Phone Number *

Emergency Contact *

Contact Phone Number *

Contact Relationship *

References

Two references are required. (PLEASE NO RELATIVES OR FRIENDS ACCEPTED) Suggested references: employer, professor/teacher, professional such as a doctor, lawyer, social worker, etc., who have known you well for at least two years.

Reference 1 Name *

Reference 1 Address *

Reference 1 Phone *

Reference 1 Relationship *

Reference 2 Name *

Reference 2 Address *

Reference 2 Phone *

Reference 2 Relationship *

Acknowledgement

I acknowledge that all information listed here is true to the best of my knowledge. I understand that if and when I discontinue my role as a volunteer at NGH/NHNH that I must return my nametag. I accept that the information provided on this application and any information disclosed during any interview may be shared with other Volunteers or staff as required to successfully screen and place me in a service at this facility.

Select One

Yes I Acknowledge

No I Don't Acknowledge

Please Answer The Following Questions:

Why do you wish to join this program? *

How did you hear about NGH/NHNH Volunteer Association? *

How long do you wish to volunteer? *

What other volunteer experience do you have?

Have you ever served on the executive of any other organization?

Special Skills I Have: (eg: Computers, Public Speaking, Crafts, Musical Talents, etc)

Volunteer Positions Summary

Please select the boxes of the volunteer services which interest you the most. The service(s) that you are able to participate in will be determined by your availability, skills and experiences as well as by our current vacancies. This will be discussed during your interview. Please refer to the Volunteer Service Description form for more details regarding each service.

Administrative Services

2nd Floor Information Desk

Main Information Desk

Office Helper

Financial Services

Patient Services

Fundraising Services

Other Services

Garden Helper

Grade One Tours

Special Events

Are you interested in being trained to feed patients/residents?

Yes

No

Schedule of Availability

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

How many times per week or per month would you like to volunteer? *