COVID Volunteer Application & Interview Form

Thank you for choosing to volunteer at this time.

Volunteering is a great way to contribute to your community, meet people, gain skills and experience.

Volunteers are an important part of our team. Many of our programs depend on the support of volunteers to be successful. At this time all of our programs and services have been modified. We are recruiting volunteers to help support the SEED with the Good Food Box project. Please complete the form below and someone will contact you ASAP.

Please complete this application form click the submit button at the bottom to get the application process started.

Contact Information

Preferred Name:

Last name:

Preferred Pronoun:

Group name:

Street 1:

City:

Province:

* Postal code: *

Preferred Phone phone:

* OK to call me here

Email address:

Dietary Needs:

Emergency Contact Information

name:

Contact Number phone:

* OK to call here

Email address:

Relationship:

References

Are you a current staff/volunteer of a local organization- please name the organization as your reference.

Do you know a staff person at the Guelph CHC who could be your reference- please use them as your reference.

1

2

name:

City:

Province:

Contact Number phone:

Email address:

Relationship:

Position Preference

During this time GCHC and the SEED have modified programs and services. Please indicate which position you are interested in helping with:

Position Preference:

* The SEED - Delivery Driver

* The SEED - Good Food Packing

* The SEED - Upcycle Kitchen

Early ON Family Greeter - future

Front Desk - future

Online COVID Administration Support

Other - Please indicate below

Special Events - future

WE Breastfeed Cafe Online Support

Availability

Please indicate the days and times you are usually available to volunteer.

Special Skills and Interests

What Skills, special qualifications or training do you have?

What motivated you to volunteer at this time?

Please tell us why you are interested in volunteering at this time. Where do you usually volunteer/work? Are you prepared to work in a possibly stressful or unfamiliar situation?

Good Food Packing, Meal Prep and Delivery

Volunteering with these programs will require that you are able to lift boxes, have cooking experience and/or have access to a personal vehicle. Please provide some insight on your ability to volunteer with these roles.

How did you hear about this opportunity?

Example: Newspaper, Radio, Internet, another volunteer, Facebook,post card.

Training

Training and orientations will be provided before and during volunteering.

Please list any requirements you have for a positive volunteering experience.

Demographic Information

You may optionally provide the following information. Please note that volunteers must be 18 during current times.

Age range:

Password

Please select a password that you can use to sign into the Guelph CHC database to update your own information, log hours or sign up for shifts.

Please enter a password that:

Is between 6 and 30 characters long
Contains both letters and numbers.

Password:

Confirm password:

Waiver Consent, Agreement and Confidentiality

PLEASE NOTE: This section includes digital versions of 4 forms. Please read the whole section carefully before showing agreement by clicking the box.

DATABASE WAIVER CONSENT FORM

I give permission for the Corporation of the Guelph Community Health Centre (GCHC) to store my personal information (name and contact information) as a current volunteer for the GCHC in the Volgistics Database.

I understand my personal information will be used for the purpose of populating the volunteer database. The Volunteer Database uses Volgistics as our database provider. Volgistics is an American company and my data will be held in a database that is located in the United States that is very safe and secure and the US does NOT have access to any of the information stored. The only personal information that will be stored will include: First and last name, telephone number, mailing address and email address if provided.

Volgistics will allow safe and best practices which involve the up keep of volunteer files, how long individuals have been volunteering for, what roles they are currently in and maintaining statistical information to help in supporting the volunteer program at the GCHC.

VOLUNTEER AGREEMENT FORM

GCHC expects volunteers to be:

Reliable, Punctual, Timely communication with not being able to full fill tasks or assignments, Respect for confidential information, Attendance at required training, Interest in the volunteer position, Willingness to work within the values of GCHC and adhere to centre’s policies and procedures.

What volunteers can expects from GCHC:

Direction and support from a supervisor, Training and supervision on the job, A program supervisor that will be your primary contact, Timely information regarding any changes in the conditions surrounding your job, Answers to questions, Recognition for your work.

ACKNOWLEDGEMENT OF CONFIDENTIALITY OF INFORMATION FORM

By nature of the work they do, staff, board members, volunteers, students, consultants and contractors of the GCHC will at times have access to personal information about customers, employees, students and volunteers, which is of a private and confidential nature.

Because of this, I will:

• Respect the privacy of clients/participants and other employees, students and volunteers at all times.

• Treat all GCHC clinical, program, administrative, and financial information about customers as confidential and take all necessary precautions to protect it.

• Ensure that private and confidential information is not inappropriately accessed, used or disclosed either directly or by virtue of access to passwords to the computer system.

• Disclose confidential information when required to do so by law.

• Sign that they have read and reviewed this policy.

Violation of privacy and confidentiality may include but is not limited to:

• Accessing personal information that is not required for work/volunteering purposes.

• Misusing or disclosing personal information (verbally, through the computer system or in hard copy) without proper authorization.

• Altering personal information of clients/participants, employees, students or volunteers.

• Disclosing to another person personal user names and passwords to enable unauthorized access to personal information.

A breach of confidentiality will result in disciplinary action and/or termination.

The conditions outlined in this policy continue beyond the cessation of a relationship with GCHC.

COVID-19 VOLUNTEER HEALTH & SAFETY ACKNOWLEDGMENT FORM

Thank you for your willingness to volunteer during these complex and challenging times. The COVID-19 pandemic has necessitated changes to routines and practices to keep volunteers, clients and staff safe and healthy during volunteering.

This document is designed to ensure that volunteers are aware of the risks and have made an informed choice in agreeing to volunteer.

In the event of a public health emergency, volunteers may be exposed to a higher then normal level of risk or exposure in the work environment. Volunteers assisting with the delivery of community support services should be aware of the specific risks listed below. It is important to note that this list is not exhaustive; there are likely additional risks that have not been listed.

Exposure to and/or contraction of COVID-19

In volunteering during the COVID-19 pandemic, I fully understand the following:

• I agree to self monitor for COVID-19 as per provided information outlined by public health.

• I will notify the GCHC if I become unwell.

• I will stay home if suspected that I am unwell.

• I agree to adhere to public health recommended social distancing guidelines, hygiene and hand-washing procedures.

• If required for my role, I will receive training on use of PPE and will follow the procedure outlined by the GCHC and public health.

• I will review and agree to work within the boundaries of the position that I am asked to do.

• I will/have review the Volunteer Canada, Volunteering During COVID-19 checklist and proclaim that I am fit to volunteer.

• I will ensure that I been provided with guidance on mitigating risk and will discuss these risks with my family.

• I accept the related risks and agree to take all reasonable precautions to manage these risks in order to avoid personal injury.

• I will immediately notify the GCHC of any incident that involves property damage or personal injury during my volunteer duties.

• Either the GCHC or I may terminate my volunteer activities at any time.

BY CHECKING OFF THE BOX, I ACKNOWLEDGE HAVING READ, UNDERSTOOD AND AGREED TO THE ABOVE CONDITIONS, RELEASE AND WAIVER, FOR THE VOLUNTEER ROLE THAT I AM ASSIGNED AND AGREE TO PERFORM FOR THE GUELPH COMMUNITY HEALTH CENTRE.

I Agree