Online Volunteer Application form

All information on this Volunteer Application form whether submitted online or in paper directly to Grace Hospital will be entered to a website owned by Volgistics, Inc. and not the Grace Hospital or the Winnipeg Regional Health Authority (WRHA).

Volgistics is a third party contracted to manage and store all information on volunteers collected by Grace Hospital, including, but not limited to: this application, personal information, volunteer assignments, service hours, awards, etc. Volgistics currently stores this information on servers located outside of Canada. This information will be subject to the laws of the country where it is kept.

Grace Hospital and the WRHA are not responsible for any lost or misdirected data or for any delays while data is being sent to or stored on the Volgistics website.

Information about Volgistics’ Security Features, Privacy Policies and Terms of Use can be found on its website at www.volgistics.com.

 
Contact Information
Mr. Ms. Mrs. Miss
Last Name: First Name:  
Address: Postal Code:
City: Province:    
Phone: Business: Email:
Cell:        
I prefer to receive calls at Home Business Cell Best Time:
Age: 16-17 18+      
 
Current Status

  Employed Unemployed Retired Student

Employment History

Company Name
Employer
Your Job Title From To Reason for Leaving
 
Volunteer Work
Please list organizations that you currently are volunteering for or have volunteered for in the past including: community clubs, schools, religious organizations, professional associations, non-profit organizations, sporting organizations, etc.

Organization Your Responsibilities From To Reason for Leaving
Have you ever applied to volunteer with this organization before? Yes No
If yes, when?
 
Education
Your highest level of education obtained:

  High school College / University Trade / Business
 
Check the areas/departments that interest you:
Please note: We have limited opportunities during the evenings and on weekends.

Patient Care Areas Youth Program (16-17) Clerical / Administration
Retail Non-Patient Care Areas Special Events
 
Volunteer Commitment / Availability
Please check the preferred time period(s) that you are available to volunteer. Please also specify the times you would arrive for your shift and then have to leave.

Note: We require a minimum commitment of one shift at the same time each week.

  Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Morning (8AM-12PM):
Afternoon (12PM-4PM):
Evening (4PM-8PM):
 
Length of Commitment? Minimum 3 months 6 months 1 year More than 1 year
 
Optional
If you wish to have anything further to be taken into consideration when determining a volunteer placement (for example: mobility issues, back problems or allergies), you may list those issues in the space provided:
 
Who would you like us to contact in case of an emergency?
Name:    
Phone (H): Phone (W):
Phone (C):    
 

References
If you are interviewed as a potential volunteer, you will be asked to provide three (3) references. Please note that references from family members or from personal friends will not be accepted, unless you were employed by them.

Please list three current references - past or present.

Reference Name How do you know this person? Phone # (day/evening) Email Address
1.
2.
3.

 

I hereby authorize the Grace Hospital to contact the named references to ascertain my suitability as a volunteer. I hereby release the Grace Hospital from all liability for any damage whatsoever for obtaining and using same. I further authorize the Grace Hospital 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.

 

(to be filled in later) (to be filled in later)
Signature of Applicant Date
 

Authorization and Consent
By submitting this application, I agree that the information I have provided on the form is true and accurate. Furthermore, I understand and agree that submitting this application form does not automatically register me as a volunteer. It is the policy of Grace Hospital Volunteer Services to screen all prospective volunteers. While we try to place every prospective volunteer, management reserves the right to decline applicants who do not meet our requirements and/or placement criteria. I consent to this information and information about my volunteer work with Grace Hospital to be maintained on the Volgistics website and absolve and release Grace Hospital and the WRHA from all and any liability that may otherwise accrue by reason of keeping this information on the Volgistics website and using this information for Grace Hospital purposes.

 

(to be filled in later) (to be filled in later)
Signature of Applicant Date

 

 

For those applicants under the age of 18, parental / guardian consent will be required.
Reminder to download and forward the completed Parent / Guardian Consent form.