High School and Post-Secondary students must submit their applications(and ALL documentation) during the following application windows:

High School Students

May 1 to June 30 for September to June placement

Post-Secondary Students

May 1 to June 30 for a September to May placement

January 1 to February 28 for a May to August placement

(This placement period is now CLOSED for Summer 2020)

To become a volunteer you must provide the following documentation during the application windows above:

•Be 16 years of age or older during the calendar year of application / Grade 11 or above

•Submit a completed Medical Form (CDSP)

•Submit two letters of reference

•Submit a Police Criminal Record Check (18+)

Complete this application form if you are interested in becoming a Niagara Health volunteer. Once you complete the form, please ensure you have typed the correct contact e-mail address, as we will use this e-mail to communicate with you. Click the "submit" button at the bottom and follow instructions sent to the e-mail account provided. Applications sent without forwarding documentation to volunteer@niagarahealth.on.ca will be considered incomplete.

Contact Information

Please provide us your most current contact details including your email address. If you were REFERRED to volunteer by a Niagara Health Volunteer please record their first and last name in the boxes below your e-mail address.

First Name:

Last Name:

Title:

Street 1:

City:

Province:

* Postal Code: *

Home phone:

OK to call me here

Work phone:

OK to call me here

Cell phone:

OK to call me here

E-Mail:

First Name:

Last Name:

Which placement are you applying for? Please indicate the placement PERIOD you are applying for. Your options include: SEPT to JUNE (High School) / SEPT to MAY (Post-Secondary) / MAY to AUG (Post-Secondary)

Demographics-Optional

This information is used to help get a better idea of the demographic make-up of our volunteers.

I identify my gender as..:

How did you hear about us?:

Could we include you on our Volunteer Resources Birthday List?(Yes or No):

Age

To become a volunteer, you must be 16 years of age or older. Please click the box below to confirm that you will be 16 years of age in this calendar year.

Over the age of 16:

Language

Do you speak a language other than English? If so, please choose the language you speak fluently.

Language spoken other than English:

Assignment & Site Preference

Volunteer opportunities are based on the current needs of the organization and change on an on-going basis. We have several volunteer positions supporting patients, hospital services, auxiliaries, the Walker Family Cancer Centre and Niagara Health Foundation. Be advised, volunteers are not permitted to take on any tasks or responsibilities that only members of a licensed or regulated profession can do. (i.e. physician, physiotherapist, laboratory technician, etc.)To better assist you, please choose 3 areas of interest to you.

1st choice of assignment:

* Hospital Preference:

1st choice:

2nd choice:

Volunteering Goals & Expectations

How will volunteering at Niagara Health help meet your goals (e.g. personal/academic/employment) and what do you envision yourself doing while you are volunteering?

Interests

Do you have any hobbies, interests or special skills and talents you would like to share with us?

Education

Please list the highest level of your completed education or what education your are currently enrolled in.

Education:

Med Plus Student? (Yes/No):

If you are currently enrolled in school, which institution do you attend?

Availability

Volunteers are typically asked to commit to one 2-4 hour shift per week. Please choose ALL the time slots that you could be available for. Shift times will vary depending on the assignment. Morning (ex. 8-11 or 10-12) Afternoon (ex. 12-4 or 4-6) Evening (ex. 5-7 or 6-8). If you have specific availability in terms of hours please specify in the comment box below.

Employment

Please list your current or most recent employer, if applicable, and identify your employment status from the drop down menu.

Employment:

Employer / Organization:

City:

Province:

Work phone:

Email address:

Start Date:

Volunteer Experience

Please list up to three volunteer experiences, as applicable.

I am a past NH Volunteer or Staff:

1

2

Employer / Organization:

City:

Presently still involved?:

Work phone:

Start Date:

3

Employer / Organization:

City:

Presently still involved?:

Work phone:

Start Date:

If you have previous involvement (i.e. employment or volunteer) with Niagara Health please provide what type and which site(s):

Emergency Contact

In the event of an emergency, please provide a contact person.

First Name:

Last Name:

Home phone:

OK to call here

Work phone:

OK to call here

Cell phone:

OK to call here

Relationship:

Please list any medical conditions we should be aware of:

I Agree

1. Submitting this application form does not automatically register me as a Niagara Health (NH) volunteer, and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering.

2. The personal information collected in this application will be used as part of the application screening process to evaluate my suitability for a volunteer position.

3. I understand any misrepresentation or omission from this application may result in the rejection of my application and/or will constitute as sufficient grounds for termination as a volunteer.

4. I understand that, prior to confirmation of a volunteer position and shift time, volunteers must submit the results of a negative 2-step Tuberculosis (TB) Test and provide proof of immunization for Varicella (chicken pox), Measles, Mumps and Rubella. All volunteers must submit a CDSP (Communicable Disease Surveillance Program) form that your health care provider is required to complete.

5. I understand that, prior to confirmation of a volunteer position with NH, I must submit two letters of reference with reference to information about me, including but not limited to achievement, performance, attendance, employment/educational history, disciplinary information and reason for separation of employment and/or education.

6. I understand that, prior to confirmation of a volunteer position with NH; I must submit the results of a Police Criminal Reference Check if I am over the age of 18 years.

7. Upon agreement that you will commence volunteering, you agree to have your photograph taken for identification purposes; and to comply with the conditions of the volunteer position and the policies of the Hospital.

8. I agree to make a regular commitment to NH for a minimum of 1 year and/or a minimum of 60 hours of service.

9. I will not disclose or use, during or subsequent to my volunteer service with Niagara Health, any information (written, verbal, electronic, or other form) relating to patients, employees, volunteers or Hospital business.

10. I authorize NH to release information about me regarding my volunteer commitment while providing a reference check or specific position plan, inclusive of but not limited to dates of volunteer commitment, achievement, performance, attendance, eligibility for rehire, disciplinary information and reason for separation of volunteer commitment.

11. I give consent for my provided contact information to be shared within Niagara Health.

12. If accepted as a volunteer, I must wear my ID badge and uniform while on duty and that these items, in addition to the parking pass/access card (if applicable) must be returned to the Volunteer Department within 4 weeks of termination of appointment. A fully refundable deposit for the uniform in the amount of $20 will be required.

13. There will be a 3 month probationary period during which time either party may terminate the partnership with minimal explanation.

14. Niagara Health is not responsible for any claims for personal injury and/or property damage that may arise from or be in any way connected to my participation as a volunteer. The Hospital's insurance coverage will protect me from personal liability while I am serving as a volunteer, provided that I am acting in accordance with such directions or instructions as are given to me by the volunteer management, and I am acting reasonably, honestly and in good faith. Volunteers are not covered by workplace safety insurance through WSIB.

I Agree