Queensway Carleton Hospital - Volunteer Application Form

Volunteer Application Form

General Information

*Full Name:

Unit/Apt.:

*Street:

*City:

*Postal Code:

*Phone:

ext.

*Email:

*Have you ever volunteered at QCH?:

Have you ever volunteered at QCH?

Yes

No

If yes, when?:

*Have you ever been an employee at QCH?:

Have you ever been an employee at QCH?

Yes

No

If yes, when?:

*Is anyone else at the above address already a volunteer at QCH?:

Is anyone else at the above address already a volunteer at QCH?

Yes

No

If yes, what is their name?:

*Do you have any relatives employed by QCH?:

Do you have any relatives employed by QCH?

Yes

No

If yes, please specify name and area/department they work:

Emergency Contact

*Emergency Contact Full Name:

*Emergency Contact Phone (Home):

*Emergency Contact Phone (Cell):

*Emergency Contact Email:

Employment & Volunteer Information

*I am currently:

*Employer:

*Educational Institution:

*Grade/Year:

*Work Experience:

*Have you ever volunteered before? :

Have you ever volunteered before?

Yes

No

If yes, please provide name of agency and phone number:

*Other community involvement:

Skills & Interests

*Do you have any special skills/training and/or interests you’d like us to know about? This does not have to be related to volunteering but can be anything from a love of art to playing the xylophone:

Availability

A minimum commitment of 75 hours or 1 year and one shift of approximately 3 hours is required per week. Morning shifts are usually between 7:30 am and Noon, afternoon shifts are usually between 11:30am and 4:00 pm and evening shifts are typically between 4:00 pm and 8:00 pm. Please check all possible options for availability.

*Sunday:

Sunday

Morning

Afternoon

Evening

Not available

*Monday:

Monday

Morning

Afternoon

Evening

Not available

*Tuesday:

Tuesday

Morning

Afternoon

Evening

Not available

*Wednesday:

Wednesday

Morning

Afternoon

Evening

Not available

*Thursday:

Thursday

Morning

Afternoon

Evening

Not available

*Friday:

Friday

Morning

Afternoon

Evening

Not available

*Saturday:

Saturday

Morning

Afternoon

Evening

Not available

Program Preferences

Please consult our "About Our Volunteers" webpage for a list of programs and indicate the name(s) of those in which you would be interested.

*First Choice:

*Second Choice:

*Third Choice:

Is there anything else you would like us to know about your program preferences?:

Reasons for Volunteering

*Please describe your motivations for applying to become a volunteer at QCH:

Information in this section is for statistical purposes & completion is optional

Date of Birth:

Gender (optional):

Medical Requirements for Volunteering

*I understand that I am required to show proof of full vaccination for COVID-19 (Canadian approved) before I can start volunteering at QCH:

I understand that I am required to show proof of full vaccination for COVID-19 (Canadian approved) before I can start volunteering at QCH

Yes

No

*I understand that if I am accepted as a volunteer, I will be required to complete a Medical Health Form with my physician at my own expense; this includes a 2-step Tuberculosis test and providing immunization status for Measles, Mumps, Rubella, and Varicella:

I understand that if I am accepted as a volunteer, I will be required to complete a Medical Health Form with my physician at my own expense; this includes a 2-step Tuberculosis test and providing immunization status for Measles, Mumps, Rubella, and Varicella

Yes

No

Terms and Conditions for Volunteering

*I certify that I meet the minimum age requirement of 16 years old:

I certify that I meet the minimum age requirement of 16 years old

Yes

No

*I understand that volunteers are placed according to the needs of the hospital, their interests, skills, suitability; not all applicants are accepted:

I understand that volunteers are placed according to the needs of the hospital, their interests, skills, suitability; not all applicants are accepted

Yes

No

*I understand that if I am accepted as a volunteer, I will be expected to demonstrate QCH's values, abide by all hospital policies and procedures and fulfill the commitment I have made:

I understand that if I am accepted as a volunteer, I will be expected to demonstrate QCH's values, abide by all hospital policies and procedures and fulfill the commitment I have made

Yes

No

*I understand that a Police Check may be a requirement in order to volunteer:

I understand that a Police Check may be a requirement in order to volunteer

Yes

No

*I understand that QCH reserves the right to dismiss a volunteer from their volunteer position if, in the opinion of the hospital, continuance of the volunteer could cause detriment:

I understand that QCH reserves the right to dismiss a volunteer from their volunteer position if, in the opinion of the hospital, continuance of the volunteer could cause detriment

Yes

No

*I understand that providing false or incomplete information on this application form may disqualify me from volunteering, or result in my dismissal:

I understand that providing false or incomplete information on this application form may disqualify me from volunteering, or result in my dismissal

Yes

No

*I declare that the information provided on this form is true and complete to my knowledge:

I declare that the information provided on this form is true and complete to my knowledge

Yes

No

*Current Date:

*Upload first QCH reference form here:

*Upload second QCH reference form here:

Welcome to Queensway Carleton Hospital Website

Volunteer Application Form

Volunteer Application Form

General Information

Emergency Contact

Employment & Volunteer Information

Skills & Interests

Availability

Program Preferences

Reasons for Volunteering

Information in this section is for statistical purposes & completion is optional

Medical Requirements for Volunteering

Terms and Conditions for Volunteering

We are processing your submission.
Please do not press back or refresh.

YOUR HOSPITAL VISIT

CORNERSTONE PROGRAMS

NEWS & INFORMATION

CONTACT US

Welcome to Queensway Carleton Hospital Website

Volunteer Application Form

Volunteer Application Form

General Information

Emergency Contact

Employment & Volunteer Information

Skills & Interests

Availability

Program Preferences

Reasons for Volunteering

Information in this section is for statistical purposes & completion is optional

Medical Requirements for Volunteering

Terms and Conditions for Volunteering

We are processing your submission.Please do not press back or refresh.

We are processing your submission.
Please do not press back or refresh.