Volunteer Application 2018

Volunteer Type

Prefix (i.e Mr. Mrs)
First Name:
Last Name:
Home:
Street #/Name:
City:
Province:
Postal:
Cell:
Work:
E-mail
School (if applicable)
Grade (if applicable)
Have you previously worked or volunteered with the Brant Community Healthcare System?
If yes, where?
Where would you like to volunteer?
Gender
Interests/Hobbies/Skills

It is the responsibility of the Brant Community Healthcare System to protect its patients and staff from any disease or infection, which might be brought in by new volunteers. For this reason all new volunteers must, as a condition of volunteer placement, receive a passing health review as required by the System, in accordance with the Public Hospitals Act and other legislative acts. Repeat examinations as required by legislation or the Hospital are mandatory.
WOULD YOU CONSENT TO A HEALTH REVIEW?

HAVE YOU EVER BEEN CONVICTED OF A CRIMINAL OFFENCE FOR WHICH A PARDON HAS NOT BEEN GRANTED?

IN CASE OF EMERGENCY PLEASE NOTIFY:
Name:
Phone:
Relationship:
Address:
City:
Province:
Postal Code:

Please answer the following questions:
1. How did you hear about volunteering at the BCHS?
If other, please specify:
2. Why are you interested in volunteering?
If other, please specify:
3. Do you have any physical limitations to your activities (lifting, pushing wheelchairs, other)?
4. What other volunteer experience do you have?
5. Current occupational status:

Personal information completed on this form is collected for operational and organizational purposes and is held in strict confidence. This information will be used to determine compatibility of needs and interests of the prospective volunteer and the needs and interests of the hospital and to generate aggregated statistical data. Brant Community Healthcare System volunteer phone numbers and e-mail addresses may be given to BCHS staff or other BCHS volunteers to be used specifically to contact volunteers for Volunteer Association business/shifts.
Thank you for your interest in volunteering at the Brant Community Healthcare System. You will be notified within 3-5 business days that your application form has been received.
Orientation and training will take place when health requirements are complete and you are assigned to a position. Every effort will be made to place you in a suitable volunteer service.