Volunteer Application Form
Information
Note: A Guardian Awareness Form must be completed by applicants 16 years or younger. Click here to download the form.
Education
Formal education is not required to be a volunteer. We welcome experience of all kinds!
Are you currently a student?
If you are currently a student please complete this section:
Name of School
Are you receiving credit for your volunteer work?
If you are not currently a student, what is your highest level of education?
Employment History
Currently I am:
Company Name / Employer
Your Volunteer Work
Please list organizations in your community that you are involved with including community clubs, schools, religious organizations, professional associations, non-profit organizations, sporting organizations, etc.
Org. Name
Have you ever applied to volunteer with this organization before?
Check the community area(s) or location(s) where you would prefer to volunteer:
St. James/ Assiniboia
St. Boniface
St. Vital
Assiniboine South
River East
Transcona
Fort Garry
River Heights
Seven Oaks
Inkster
Point Douglas
Downtown
WRHA Corporate Office
Other/specific location:
Check the skills and experience you have to offer:
Clerical, Organizational
Facilitation
Training / Education
Health care
Writing
Food Handling / Service
Class 5 driver's license
Research
Fundraising Experience
Computer, Technology
Experience with children / youth
Experience with the elderly
Public Speaking
Recreation, Coaching
Check your reasons for volunteering:
Academic Credit
Learn new skills
Practice English skills
Confirmation Requirement
Help others
Referred by medical profession
Employment Experience
Improve health care
Stay active & involved
Explore careers
Social interaction
Relative / friend volunteers
Increase self-esteem
Other (Specify):
Check how you found out about our volunteer program:
Physician
School
TV
Community
Newspaper
Volunteer Centre
Volunteer
WRHA newsletter
Referral Organization
Previously a patient / client
Poster, brochure or flyer
Recruitment / Information Booth
Employee of WRHA
Internet
Relative / Friend
Previously a volunteer
Radio
Please indicate the preferred time period(s) that you are available to volunteer for the next three months. Please specify the times you would arrive for your shift and then have to leave.
How many times per week would you like to volunteer?
Health Information
Please list any intellectual or physical disabilities or health problems which may affect your ability to perform as a volunteer and that you wish to have taken into consideration when determining a volunteer placement:
Who would you like us to contact in case of an emergency?
References
Please list 3 current references such as past /present employers, teachers/instructors, youth group leaders, colleagues or a supervisor from a volunteer experience.
We do not accept family members or personal friends as references unless you were employed by them. We do accept signed reference letters that are current and on the organization's letterhead.
Name
Phone number
Fax number
I hereby authorize the Winnipeg Regional Health Authority to contact the named references to ascertain my suitability as a volunteer. I hereby release the Winnipeg Regional Health Authority from all liability for any damage whatsoever for issuing same. I further authorize the Winnipeg Regional Health Authority to maintain this information in their records and release and absolve them from all liability that may otherwise accrue by reason of their keeping this information and using it for their purpose.
Disclaimer: It is the policy of this organization to screen all prospective volunteers. While we try to place every prospective volunteer, management reserves the right to reject applicants who do not meet our requirements and/or placement criteria.
Version française de cette page
