Volunteer Application Form

Thank you for your interest in Volunteering at South Muskoka Memorial Hospital. This application will be confidential when completed. Please note you must be at least 16 years of age to apply.

Office Use Only:

Appl. Rec'd_________

Called for Interview______

Interview Date________________

Applicant's Name

Home Phone

Work Phone (if applicable)

Cell Phone (if applicable)

Applicant's Address

Town

Postal Code

I consent to receiving email at the following address

Yes

No

Email Address:

Preferred method of contact:

Emergency Contact Information

In case of an EMERGENCY, please contact:

Emergency Contact Name:

Home Phone

Work Phone (if applicable)

Cell Phone (if applicable)

Volunteering

I would like to volunteer because I like to:

Help Others

Learn New Skills

Personal Satisfaction

Meet New People

Stay Busy

Show appreciation of help received

Explore career opportunities (students)

Other

History

Please provide any information on past volunteering experience. To add additional lines, choose the "Add More" option.

Organization

Position

Time

Skills Used

Add More Remove

Do you have any specialized skills?

Do you require an extended period of time away during the year?

Would you be willing to help out with fundraising events (i.e. bake sales, craft sales, special events)?

At a later date, might you be interested in a position on the executive?

Availability

There are various time slots available for you to volunteer. Which hours will work best for you? Some programs require special times, but in general shifts are as follows. Please select all that apply and if applicable, specify the hours.

Monday

AM

PM