Volunteer Application Of Royal Inland Hospital (Page 2 of 2) in pdf

History (Volunteer, Employment, Education, Training)

VOLUNTEER: Are you presently a volunteer?

Yes

If yes, where: _______________________________________________________________ How long? ____________

Have you volunteered for Interior Health?

Yes, when/where: _________________________________

Describe any previous volunteer experience: ________________________________________________________

Are you interested in being a member of the Afternoon Auxiliary?

Yes

EMPLOYMENT: Are you currently employed:

Yes

Full Time

Part Time

Casual

Current Employer: ________________________________________________________________________________

May we contact you at work:

Yes

Previous Employment: (attach resume if you wish) ____________________________________________________

EDUCATION/TRAINING: If you are currently a student, what school/university do you attend:

__________________________________________________________________________________________________

Area of Study: ____________________________________________ Year/Grade: ___________________________

List any past relevant education/training you have: __________________________________________________

References

Please provide two references (not relatives) that have known you for at least 6 months (E.g. coach, teacher,

or previous supervisor). Please inform your references they will be contacted.

Name of Reference #1: _____________________Relationship: ____________Phone: (___) ____________________

Name of Reference #2: _____________________Relationship: ____________Phone: (___) ____________________

Emergency Contact Person: Name: _____________________________Relationship:___________________________

Telephone: Home: (___) _________________ Business: (___) _______________ Cell: (___) _________________

Parent/Legal Guardian Consent: (applicants under 19 years old)

I, __________________________, (Print Your Name) grant my child, ___________________________ (Child’s Name),

permission to participate in the Volunteer Program at __________________________________ (Organization Name).

Signature of Parent/Guardian: ________________________________________________ Date: _______________

** Please read the following carefully before signing this application **

I consent to a Criminal Record Check and/or a personal reference check to be done to ensure the protection of

children and other vulnerable clients/resident under IH care.

I will consider as confidential, all information in verbal, written or computerized form, concerning a patient, resident,

client, family member, doctor or any member of IHA personnel, and will not seek information in regard to a

patient/resident/client, nor will I disclose any such information which may come to my attention as a result of my role as

a volunteer. I understand failure to do so may result in dismissal.

Volunteer Signature: ________________________________ Date (dd/mm/yyyy):__________________________

Volunteer Application Of Royal Inland Hospital Page 2