Volunteer Application Form for Youth 15 years and older

Please complete this application form if you are interested in becoming a Chatham-Kent Health Alliance youth volunteer. Once you complete the form, click the submit button at the bottom.

Name and address

First name:

Last name:

Title:

Street 1:

Street 2:

Street 3:

City:

Province:

Postal code:

Home Phone phone:

OK to call me here

Work Phone phone:

OK to call me here

Email address:

Why do you want to volunteer at the Chatham-Kent Health Alliance?

Past Experience

Do you have any applicable work, education or volunteer experience?

Demographic Information

The following information is used only to help us get a better idea of the demographic make-up of our volunteers. Youth volunteers must be 15 years of age.

Date of birth:

Profession status:

Availability

Please indicate the days and times you are usually available to volunteer. With few exceptions, CKHA volunteers are scheduled between 8AM and 8PM on weekdays.

References

Please provide two non-family references we may contact.

1

2

First name:

Last name:

City:

Province:

Other phone:

Email address:

Please briefly describe how you know each of these references.

Parental/Guardian Consent

If you are under 18 years of age, we require consent for your application. The following section is to be completed by your parent or guardian:

I understand that my child named in this application wishes to be considered for volunteer work and I hereby give my permission for them to serve in that capacity, if accepted by the Chatham-Kent Health Alliance. I understand that they will be provided with orientation and training necessary for the safe and responsible performance of their duties and that they will be expected to meet all the requirements of their position, including regular attendance and adherence to Alliance policies and procedures. I understand they will not receive monetary compensation for their services contributed.

Please write your name and relationship to the applicant below here:

Agreement

I hereby certify that all information included in this application form is true and complete.

I give consent to the Volunteer Resources Department of the Chatham-Kent Health Alliance to contact the above-mentioned reference in connection with my application for volunteer work.

I Agree