Year-Round Program Application

I confirm that I am able to commit to at least 1 regular shift per week for a period of at least 6-months.

* I Confirm

At which site are you interested in volunteering?

Personal Information

Preferred pronouns

* Preferred first name

* Family/last name

* Address

Apartment/ Unit Number

* City

* Zip/postal

Home phone (xxx) xxx-xxxx

* Mobile phone (xxx) xxx-xxxx

* E-mail

Emergency Contact

* Contact name

* Relationship

Emergency contact email address  

* Emergency contact mobile phone (xxx) xxx-xxxx

Additional Information

Do you speak any other language(s) other than English?

Will you be in school while volunteering?

If you answered yes to the previous question, please indicate your year of study and the name of your school.

Do you have an immediate family member who works or volunteers at Mackenzie Health? If yes, please state the relationship:

Have you ever volunteered at Mackenzie Health before?

If so, when:

Please inform us of your current commitments and responsibilities (school, working, family, job searching, etc.). As a reminder, the volunteer program requires a minimum of one 2-4 hour shift per week.

Please describe how your strengths can contribute to an 'Exceptional Patient Experience.'

What is your preference regarding availability? Important: Not all placements are available at any given time.

Weekday Mornings

Weekday Afternoons

Weekday Evenings

Weekend Mornings

Weekend Afternoons

Weekend Evenings

Work/Volunteer Experience (current or past)

Name of Organization

Roles

Duration (mm/yy-mm/yy)

Name of Organization

Roles

Duration (mm/yy-mm/yy)

Name of Organization

Roles

Duration (mm/yy-mm/yy)

Reference Information

References: Upon acceptance, we will be asking these individuals to complete a reference on your behalf. Please select a referee if they have known you for at least one semester/year (preference) in a professional manner (employer, supervisor, teacher, coach, etc.). We do not accept references from family, friends of family, personal friends or fellow students.

Reference 1

* Name of Referee

* Referee's Email Address

Referee's Phone Number

Referee's Occupation

Referee's Place of Employment

Reference 2

* Name of Referee

* Referee's Email Address

Referee's Phone Number

Referee's Occupation

Referee's Place of Employment

Resume

Please attach your resume here:

Declaration

I acknowledge and understand that the above information is true and complete to the best of my knowledge. I understand that a false statement may disqualify me or cause my dismissal.

*

I have carefully considered my ability to commit to a position before submitting this application. I understand that the hospital reserves the right to release volunteers from their placement if they are unable to fulfill the duties or the time commitment required by the placement.

*

I understand that all volunteers must agree to provide a Vulnerable Sector Check and a Health Screening Check upon acceptance into the program. I understand that any costs associated with obtaining these documents are not covered by Mackenzie Health. *All volunteers must have completed a 2-Step Tuberculin Skin Test.

*

I understand that there is a $30 fee required for the volunteer uniform and ID badge.

*

I understand that Mackenzie Health receives applications far in excess of the placements we have available and regrettably are not able to offer all candidates a placement.

*

I agree to receive electronic communication from Mackenzie Health and I give permission for the information I have provided on this form to be given to Mackenzie Health staff and volunteers in connection with a potential volunteer placement at the hospital. Mackenzie Health communicates via email so please make us a safe sender to ensure you recieve any correspondance from us.

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