Brampton Civic Hospital: Pandemic Volunteer Application

Please complete this application form if you are interested in becoming a William Osler Health System pandemic volunteer at Brampton Civic Hospital. Please read the following information carefully:

Applicants must meet the following criteria prior to applying:

• Applicant must be a minimum 15 years of age at the time of application

• Must be comfortable wearing a mask throughout their shift

• Must be able to commit to a weekly schedule of a minimum of one shift per week (4-8 hours)

• Must be able to volunteer for at least 60 hours

For reasons of patient safety, hospitals should have documented proof of immunity to Measles, Mumps, Rubella and Varicella as a condition of recruitment for all volunteers. A two-step Mantoux test is also required (TB). Priority will be given to those who have proof of completed immunizations.

At this time we are recruiting volunteers for pandemic roles which includes assisting with way-finding and screening. Please note that our organization needs are evolving so you may be engaged in other roles as per Osler's needs.

Pandemic Volunteer Requirements

The current age requirement to volunteer at William Osler Health System is 15 years of age or older. Do you meet the age requirement?

Yes:

No:

Type

Please select one option: Adult, University/College or High School

Type:

Contact Information

First name:

Last name:

Street 1:

Street 2:

City:

Province:

* Postal code:

Home phone:

Cell phone:

Email address:

Emergency Contact

In the event of an emergency whom should we notify?

First name:

Last name:

Title:

Street:

City:

Province:

Postal code:

Home phone:

Work phone:

Relationship:

Pandemic Volunteer Opportunity

Please share why you are interested in volunteering at Osler as a pandemic volunteer.

Immunizations

Priority will be given to those who have proof of completed immunizations. For reasons of patient safety, hospitals should have documented proof of immunity to Measles, Mumps, Rubella and Varicella and a two-step Mantoux test is also required (TB).

Please select which proof of immunization you currently have:

Immunization:

Availability

Day/Times Availability: Indicate the days and times you are available. Please note timings vary depending on each role.

I Agree

I understand and agree that submitting this application form does not automatically register me as a William Osler Health System volunteer, and that there may be certain requirements I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering.

By submitting this form, I attest that the information I have provided on the form is true and accurate.

I Agree