Adult Volunteer Application Form 2013.pdf - Women's College ...

VOLUNTEER APPLICATIONYour Personal InformationLast Name First Name Mr. Mrs. Ms. Dr.Apt.AddressCity Postal Code E-mail AddressHome Phone No.Cell No.Volunteer ExperienceOrganizationVolunteer PlacementFrom_______to_______ (dates)Describe duties____________________________________________________________________________________________________________________________________________________________________________________________OrganizationVolunteer PlacementFrom_______to_______ (dates)Describe duties____________________________________________________________________________________________________________________________________________________________________________________________OccupationAre you currently employed? Yes No RetiredOccupation (If retired, previous occupation)EmployerEducationAre you a student? Yes NoIf you are a student, please indicate your:School ________________ Academic Program ________________Year of Study ________________If you are not a student please indicate your educational background:__________________________________________________________________________________________________________________________________________________________________________How did you hear about our volunteer program?FriendInternetAt the hospitalOther _______________FOR OFFICE USE ONLYAPPLICATION RECEIVED: DATE INTERVIEW DATE START DATEDR FORM OUT DR FORM RETURNED PLACEMENTPlease turn over

Your SkillsPlease indicate skills and interests that may be relevant to volunteering at the hospital:Communication Skills Administration/Office OrganizationFundraising/Event Planning Retail Sales or Management “People” skillsLanguages spoken: ________________________________Computer skills: None Basic Regular UserAdditional Skills____________________________________________________________________________Your InterestsWhy are you interested in volunteering at Women’s College Hospital?__________________________________________________________________________________________________________________________________________________________________________Are you interested in any specific volunteer opportunity, department, or program?__________________________________________________________________________________________________________________________________________________________________________Your AvailabilityCircle the day(s) and time(s) you are available to volunteer. Please note that volunteer opportunities are not availablenights or weekends.MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAYMorningMorningMorningMorningMorningAfternoonAfternoonAfternoonAfternoonAfternoonComments on Availability:____________________________________________________________________________________Emergency Contact InformationLast Name First Name RelationshipHome Phone No. Business No. Cell No.ReferencesYou are required to submit 2 written references with this application – people you have worked or volunteered with, other thanfamily membersPlease read and check before signingAll the information I have provided on this application is true. I understand that misrepresentation of anyinformation is cause for dismissalI understand that my placement as a volunteer is dependent on my skills, suitability, interests and availablepositionsIf placed as a volunteer I agree to comply with the Privacy Code of Women’s College HospitalI understand that the references I submit will be verified and that there is a trial period for all new volunteersSignature of Volunteer ___________________________Date: _______________Please return to: Volunteer Resources, Women’s College Hospital76 Grenville Street, Toronto, ON M5S 1B2 416-323-6180