Hanover & District Hospital - Volunteer Application

Please ensure that all questions are completed as fully as possible. All volunteer information is held in strict confidence.

Fields marked with an asterisk (*) must be filled out.

Name:*

Telephone (Home):*

Telephone (Work):

Email Address:

Fax:

Address:*

Emergency Contact Name :*

Emergency Contact Relationship :*

Emergency Contact Phone (Home):*

Emergency Contact Phone (Work):

Please indicate your area(s) of interest :*

Day Hospital
Activation - Recreation
Emergency Department
Prenatal Clinic
Diagnostic Imaging
Knitting
Television Service
Gift Shop
Administration - Auxiliary
Special Projects as needed
Greeter

I am currently (please check where applicable) :*

employed full-time or part-time
employer
position
past employment
employer
position
a homemaker
retired from career as:

other
please specify

Previous Volunteer Experience:

Skills :*

Clerical
People
Computer
Sales
Knitting
Business
Other
please specify

Other Languages Spoken :

What motviated you to choose Hanover and District Hospital to volunteer your services? :*

How did you learn of the Volunteer Program ? :*

I am able to volunteer: (please check where applicable) *

References: (Please check box to agree) *

I hereby authorize Hanover & District Hospital to contact, in strict confidence, the following references. Please give names of professionals - eg. doctor, teacher, lawyer - NOT a friend or relative. Thank you.

Reference #1 Name:*

Reference #1 Occupation :*

Reference #1 Address including city and postal code:*

Reference #2 Name:*

Reference #2 Occupation :*

Reference #2 Address including city and postal code:*

Agreement : *

I agree to comply with the policies and guidelines as outlined in the Orientation Manual for Volunteers.

I do not agree