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Home > Forms > Volunteer Application

Volunteer Application

This form is available in alternate formats upon request. Please contact us by email or 1-800-742-6509.

For privacy reasons, please do not include personal information containing diagnoses and/or treatments.

Volunteer Application

Step 1 of 5

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CONTACT INFORMATION

Name

First Middle Last

Phone

Address

Street Address Town / City Province Postal Code

Are you 15 years of age or younger

Yes

Please tell us your age

Parent / Guardian Awareness: You will receive a printable PDF copy of this application via the email address specified. Please print this document and obtain the required guardian / parent signature.

EDUCATION

Not required to be a volunteer – we welcome experience of all kinds.

Are you currently a student?

Yes

School Name

Grade Level / Year of Study

Course of Study

Expected Date of Graduation (dd-mm-yyyy)

DD dash MM dash YYYY

Are you receiving credit for your volunteer work?

Yes

# of hours

By when? (dd-mm-yyyy)

DD dash MM dash YYYY

What is your highest level of education?

Degree / course of study

(please specify)

Other education level

(please specify)

EMPLOYMENT & VOLUNTEER HISTORY

Currently, I am…

Company Name / Employer

(current or last)

Job title

(current or last)

Employed from (dd-mm-yyyy)

DD dash MM dash YYYY

Employed to (dd-mm-yyyy)

DD dash MM dash YYYY

Reason(s) for leaving

Volunteer Work

Organization

Time Period

Responsibilities

Reason(s) for leaving

List organizations in your community that you are involved with (incl. Community clubs, schools, religious organizations, professional associations, non-profit organizations, sporting organizations, etc.)

Have you ever volunteered with this organization before?

Yes

When were you a volunteer? (dd-mm-yyyy)

DD dash MM dash YYYY

Select the site where you want to volunteer

What skills and experience you have to offer?

(check all that apply)

Class 5 driver’s license

Clerical, organizational

Computer, technology

Experience with children/youth

Experience with elderly

Facilitation

Food handling / service

Fundraising experience

Health care

Languages

Public speaking

Recreation / coaching

Research

Training / education

Writing

Other

Other skills

(please specify)

What are your reason(s) for volunteering?

(check all that apply)

Academic credit

Employment experience

Explore careers

Increase self-esteem

Learn new skills

Help others

Improve health care

Social interaction

Relative / friend volunteers

Practice English skills

Stay active / involved

Other

Other reasons

(please specify)

How did you find out about our volunteer program?

Community

Employee of SH-SS

Info booth

Newspaper

Physician

Poster / brochure / flyer

Previously a patient / client

Previously a volunteer

Radio

Relative / friend

School

Volunteer

Website / Social Media

Other

(check all that apply)

Other source

(please specify)

AVAILABILITY

Select preferred time periods you are available to volunteer for the next three months. Specify times you would arrive/leave your shift.

Day(s) of the week

(choose all that apply)

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Time of Day

(choose all that apply)

Morning

Afternoon

Evening

Arrival Time

Hours

Minutes

AM/PM

Departure Time

Hours

Minutes

AM/PM

How many shifts a week would you like to volunteer?

Are there times of the year that you are not available to volunteer?

Are you interested in volunteering for special projects or events?

Yes

Health Information

Please list any intellectual or physical disabilities or health problems which may affect your ability to perform as a volunteer and that you wish to have taken into considerations when determining a volunteer placement.

e-Signature

Name

This field is for validation purposes and should be left unchanged.

After clicking on the ‘Submit’ button, you will see a page confirming that your submission has been received.

Healthier people. Healthier communities. Thriving together.

Southern Health-Santé Sud

Partnering with our communities, we provide safe, accessible and sustainable people-centred health care.