Application Form

PROFILE INFORMATION

Please complete the application form if you are interested in becoming a volunteer at the Queen Elizabeth Hospital.

First name:

Last name:

Title:

Street 1:

City:

Province:

Postal code: *

Home phone:

* OK to call me here

Cell phone:

OK to call me here

Email address:

DEMOGRAPHIC INFORMATION

This information is only used to get a better idea of the demographic makeup of our volunteers.

Please describe any related work and/or volunteer experience.

List your special skills, hobbies and interests.

Please indicate why you are considering volunteering.

Please provide information for a contact person in case of an emergency.

First name:

Last name:

Home phone:

Cell phone:

Please provide contact information for two references not related to you and that have known you for more than 12 months.

First name:

Last name:

Home phone:

Work phone:

Do you have any health restrictions that might affect you as a volunteer at the hospital?

I consent to having my volunteer information stored on the Volgistics volunteer management system which is external to Health PEI.

I Agree