Jeunes Volontaires Age ?? to ?? All information on this Volunteer Application Form submitted to St. Boniface Hospital will be entered into a website owned by Volgistics, Inc. and not the St. Boniface Hospital or the Winnipeg Regional Health Authority (WRHA). Volgistics is a third party contracted to manage and store all information on volunteers collected by St. Boniface Hospital, including, but not limited to: this application, personal information, volunteer assignments, service hours, awards, etc. Volgistics currently stores this information on servers located outside of Canada. This information will be subject to the laws of the country where it is kept. St. Boniface Hospital and the WRHA are not responsible for any lost or misdirected data or for any delays while data is being sent to or stored on the Volgistics website. Information about Volgistics’ Security Features, Privacy Policies and Terms of Use can be found on its website.Contact InformationMarital Status:Mr.Ms.Mrs.MissLast name:First name:Address Adresse postale Ville AlbertaColombie-BritanniqueManitobaNouveau-BrunswickTerre-Neuve-et-LabradorTerritoires du Nord-OuestNouvelle-ÉcosseNunavutOntarioÎle du Prince-ÉdouardQuébecSaskatchewanYukon Province Postal Code Phone:Business:Mobile:I prefer to receive calls at:HomeBusinessMobileBest Time to Call: : HH MM AM PM Email: Employment HistoryCurrent employment status:studentemployedunemployedCompany Name / EmployerJob TitleFrom: Format de date : YYYY dash MM dash DD To: Format de date : YYYY dash MM dash DD Reason for Leaving? Have you volunteered before?YesNoVolunteer WorkIf possible, please list the last two organizations that you have volunteered for including: community clubs, schools, religious organizations, professional associations, non-profit organizations, sporting organizations, etc.Organization #1Your Responsibilities:From: Format de date : YYYY dash MM dash DD To: Format de date : YYYY dash MM dash DD Reason for Leaving? Organization #2Your Responsibilities:From: Format de date : YYYY dash MM dash DD To: Format de date : YYYY dash MM dash DD Reason for Leaving? Have you ever applied to volunteer with this organization before?YesNoIf yes, when? EducationFormal education is not required to be a volunteer. We welcome experience of all kinds.High School:Course of Study:Start Date: Format de date : MM slash DD slash YYYY End Date: Format de date : MM slash DD slash YYYY Are you receiving credit for your volunteer work?YesNoRequired number of hours:By when? Format de date : YYYY dash MM dash DD For whom do you require the hours? AvailabilityPlease check the preferred time period(s) that you are available to volunteer. Please also specify the times you would arrive for your shift and then have to leave.Monday morning afternoon evening Tuesday morning afternoon evening Wednesday morning afternoon evening Thursday morning afternoon evening Friday morning afternoon evening Saturday morning afternoon evening Sunday morning afternoon evening Time CommitmentI'm available for:3 months (minimum)6 months1 year or moreShifts per week?1 shift2-3 shifts4+ shiftsInterested in special events?YesNoAre there times of the year you are not available? Interests and SkillsPlease check the areas / departments that interest you: Ambassador Auxiliary Chad’s Bar Clerical Assistant Communication Dept. End of Life Companion Foundation Friendly Visitor Gift Shop Life Stories Meal Assistant Medical Escort Musician Pet Visitor Physiotherapy Dept. Recreation Spiritual Care Volunteer Nutritionist Other Area /Department Please specify:Please check the skills and experience you have to offer: Clerical, Organizational Communication Skills Computer / Technology Creative Ideas Experience with the Elderly Fundraising Experience Interpersonal Skills Music Ability Language Retail Experience Social Interaction Which language(s)?:Please check your reason(s) for volunteering: Academic Credit Contribute to Healthcare Employment Experience Explore careers Help others Increase self-esteem Learn new skills Practice English skills Referred by medical professional Relative / friend volunteers Social interaction Stay active & involved Other Please specify:Please check how you found out about our volunteer program: Another Volunteer Community Employee at Deer Lodge Newspaper Physician Poster / brochure / flyer Previously a patient Recruitment Booth Referral Organization Relative / Friend School Volunteer Manitoba / MYVOP Website Other Which organization?Please specify: OptionalIf you wish to have anything further to be taken into consideration when determining a volunteer placement, you may list those issues in the space provided.optional In case of an emergency...Who would you like us to contact?Name:Home:Work:Mobile: ReferencesIf you are interviewed as a potential volunteer, you will be asked to provide three (3) references. Please note that references from family members or from personal friends will not be accepted, unless you were employed by them. Authorization and ConsentFor those applicants under the age of 18, parental / guardian consent will be required. Please download and forward the completed Parent / Guardian Consent form. Authorization:By submitting this application, I agree that the information I have provided on the form is true and accurate. Furthermore, I understand and agree that submitting this application form does not automatically register me as a volunteer. It is the policy of the Deer Lodge Centre Volunteer Services to screen all prospective volunteers. While we try to place every prospective volunteer, management reserves the right to decline applicants who do not meet our requirements and/or placement criteria.I agreeI disagreeConsent:I consent to this information and information about my volunteer work with the Deer Lodge Centre to be maintained on the Volgistics website and absolve and release the Deer Lodge Centre and the WRHA from all and any liability that may otherwise accrue by reason of keeping this information on the Volgistics website and using this information for Deer Lodge Centre purposes.I consentI do not consent
