Join Our Team | Ross Memorial Hospital Volunteers

Last Name: ^*

First Name: ^*

Number/Street/Apt: ^*

City: ^*

Postal Code: ^*

Please check preferred method of contact:

Home Phone

Mobile Phone

E-mail

Emergency contact details:

Name: ^*

Relationship: ^*

Phone: ^*

E-mail: ^*

Employment status:

Full Time Part Time Retired Student

Students:

High School Post-Secondary

Other:

Work Experience:

Volunteer Experience:

Availability (check all appropriate boxes):

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Morning
Afternoon
Evening

Volunteer service interest:

Patient Care Areas Support Service Areas (e.g. Info Desk, Gift Shop, Fundraising)

How did you hear about the volunteering at the Ross Memorial Hospital?

Hospital Website Referral (e.g. staff, physicians, volunteer) School (High School, Post-Secondary) Other

Please list your hobbies, interests, skills:

For completion by Parent or Guardian of applicant under age of 18 years:

My child has my permission to participate as a volunteer at Ross Memorial Hospital.

Parent/Guardian Name:

Parent/Guardian Phone:

Parent/Guardian Signature:

Date:

Declaration

I certify that I am 16 years of age and older.
I certify that I will undergo a criminal background check with the vulnerable sector prior to my start date, if I am offered a volunteer placement at RMH.
I understand that my criminal background check must be acceptable to the hospital HR policies.
I agree to adhere to all related RMH policies and procedures.
I understand that I will have a pre-volunteer health assessment and submit immunization information to the RMH Occupational Health department, if selected to volunteer at RMH.
I accept the responsibility to maintain my knowledge/understanding of my volunteer role and remain current on emergency code procedures.
I understand that as part of my role as a volunteer I may be required to attend mandatory training sessions and agree to participate as required.
I understand that I will be required to serve a three month probationary period.
I understand that not every applicant may be accepted as a volunteer.
I understand that I may be placed in a volunteer role that could be outside my expectations/career background.
In the event that my volunteer involvement is not compatible with the hospital’s requirements my volunteer experience may be terminated.
I certify that the information I have provided is true and understand that any misrepresentation or omission may result in my dismissal if accepted as a volunteer.
I hereby grant permission for my personal contact information (phone number and email) to be shared with my placement supervisor, the RMH Volunteer Department, RMH Management and other volunteers in my work area for the purposes of scheduling and sharing/relaying information.
I agree to provide references (excluding family members) when requested to continue with the requirement process. I agree that no liability or damage shall be incurred by my present/previous employer(s) as a consequence of their release of such information.

Signature:

Date: