Volunteer Application

Personal Information

First name(Required)

Last name(Required)

Address(Required)

Street Address City ZIP / Postal Code

Home phone

Cell phone(Required)

Email address(Required)

Date of birth(Required)

Emergency health information(Required)

Is there any information a health care professional should know should you suddenly become ill? i.e., allergies, medical conditions, contact lenses, etc. Please put N/A if it is not applicable to you.

Emergency contact name(Required)

Emergency contact phone(Required)

Relationship to applicant(Required)

Employment History

Are you currently employed?(Required)

Yes

No

Current employer(Required)

Current work schedule(Required)

Full time

Part time

Casual

May we contact you at work?(Required)

Yes

No

Phone(Required)

What previous jobs have you had?(Required)

Please put N/A if it is not applicable to you.

Education/Training

Are you currently a student?(Required)

Yes

No

Current school/university(Required)

Area of study and/or grade level(Required)

Please list any skills from either present or past employment/education which will contribute to your success as a volunteer.(Required)

Have you any specific Hospital or Health Care training?(Required)

Yes

No

Please describe your hospital or health care training(Required)

Abilities/Skills

Please describe your personal talents, hobbies, interests and special skills.(Required)

Do you speak or write languages other than English? Please specify.(Required)

Interests

Why are you interested in volunteering at St. Michael’s Care Centre?(Required)

What type of volunteering opportunities are you looking for?(Required)

Are you interested in assisting with Special Events?(Required)

Yes

No

Screening

If requested, are you willing to submit to a criminal records check?(Required)

Yes

No

REFERENCE 1

Name(Required)

Relationship to you(Required)

Phone(Required)

Email address(Required)

REFERENCE 2

Name(Required)

Relationship to you(Required)

Phone(Required)

Email address(Required)

Commitment

I confirm that the information in this volunteer application is complete and true.(Required)

I confirm that the information in this volunteer application is complete and true.

I authorize St. Michael’s Centre to contact the references listed and give permission to these references to release all relevant information requested(Required)

I authorize St. Michael’s Centre to contact the references listed and give permission to these references to release all relevant information requested

I agree to attend a mandatory Orientation for Volunteers & to complete the required training.(Required)

I agree to attend a mandatory Orientation for Volunteers & to complete the required training.

I agree to respect the confidential nature of the volunteer role, and I understand that breach of confidentiality is cause for dismissal from volunteer service.(Required)

I agree to respect the confidential nature of the volunteer role, and I understand that breach of confidentiality is cause for dismissal from volunteer service.

I agree to abide by the Centre’s policies, rules, and regulations.(Required)

I agree to abide by the Centre’s policies, rules, and regulations.

I give permission for the Dept. of Volunteer Services to keep my personal information on site in both paper and electronic format. I understand that this information will only be disclosed to staff who need this information to contact me regarding matters relating to my volunteer work.(Required)

I give permission for the Dept. of Volunteer Services to keep my personal information on site in both paper and electronic format. I understand that this information will only be disclosed to staff who need this information to contact me regarding matters relating to my volunteer work.

Personal Information

Employment History

Education/Training

Abilities/Skills

Volunteer Experience

Interests

Screening

Commitment