Volunteer Questionnaire

  Contact Information

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Name:

 

 

 

     

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City/Province/Postal:

 

    

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If you respond and have not already registered, you will receive periodic updates and communications from St. Joseph's Health Centre Foundation.


 
Question - Not Required - Date of Birth (Optional)




   


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Question - Required - How would you like to volunteer?
Please make between 1 and 3 selections from the choices below.

 
Question - Not Required - Were you born at St. Joesph's?


 
Question - Not Required - Were you a patient at St. Joesph's?


 
Question - Not Required - Is St. Joseph's your community hospital?


 
Question - Not Required - Employment / Education / Volunteer Experience
Please make between 1 and 3 selections from the choices below.

 

(Maximum response 255 chars, approx. 5 rows of text)

 

 
Question - Not Required - Have you volunteered with the St. Joseph's Health Centre in the past?


   


 

EMERGENCY CONTACT (OPTIONAL)

   


   


   


   


 

Disclaimer:

I certify that all information in this application form is true and complete. False statements or omissions are grounds to terminate the relationship no matter when they are discovered. I authorize the Foundation staff to contact the above references to determine my suitability for a volunteer position. If accepted as a volunteer, I agree to comply with the policies and procedures of St. Joseph’s Health Centre and the Volunteer Services Department as outlined during orientation and training.

I understand that SJHC is committed to protecting the privacy of my personal information in its possession. Personal information in SJHC’s possession will be kept confidential and it will not be sold, traded or loaned to any other organization. The information on this form will be used by SJHC to identify volunteer interest and determine suitability for a specific volunteer position. The volunteer/SJHC relationship can end at any time by either party (this relationship is at will and is not a contract of employment).

   


 
Question - Not Required - Date:




 

*If you are under the age 18 please obtain parental or legal guardian consent

   


   


   Please leave this field empty