Volunteer Application YES, I want to help ARCH Hospice care for residents and their families Volunteers are the heart of ARCH Hospice and allow us to provide comfortable end-of-life journeys to Algoma District residents and their families. With over 100 regular volunteers, your time is not only precious to us, but also the residents and their loved ones. We have many opportunities that allow you to pick a volunteer position you feel most comfortable in and best suits your skills. Volunteer Information First Name ________________________________________ Last Name ________________________________________ Address __________________________________________________________________________________ Apt _________ City _____________________________________ Prov _____ Postal Code __________ Country __________________ Phone (home) _______________________ (business) ________________________ (cell) _________________________ Birth Date MM/ YY Email _______________________________________________________________________________ Why do you want to volunteer in a palliative setting? ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ How did you hear about volunteer opportunities at ARCH? ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ Past Volunteer Experience Organization Position Date Duties 1 _____________________ __________________ MM/ YY ________________________________________________ 2 _____________________ __________________ MM/ YY ________________________________________________ 3 _____________________ __________________ MM/ YY ________________________________________________ 4 _____________________ __________________ MM/ YY ________________________________________________ Special skills or qualifications from past employment, volunteering, or other experiences: _______________________ _______________________ _______________________ _________________________ _______________________ _______________________ _______________________ _________________________ _______________________ _______________________ _______________________ _________________________ _______________________ _______________________ _______________________ _________________________ Volunteer Application What areas are you interested in volunteering? Administration Office General Housekeeping Front Desk Reception Kitchen Maintenance Fundraising & Events Palliative Complementary Therapy Special Projects Gardening & Grounds keeping Availability: Sunday Monday Tuesday Wednesday Thursday Friday Saturday 9am – 12pm 12pm – 4pm 4pm – 8pm Night Respite Emergency Contact Information Name _______________________________________________ Relationship ____________________________________ Phone (home) _______________________ (business) ________________________ (cell) _________________________ References Name Phone Number Nature of Relationship 1 ____________________________ __________________ _________________________________________________ 2 ____________________________ __________________ _________________________________________________ 3 ____________________________ __________________ _________________________________________________ Agreement & Signature By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal. Signature ___________________________________________________ Date______________ Submit For Office Use _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _ Registered Charity # 86395 3766 RR0001 ARCH Hospice 229 Fourth Line West, Sault Ste. Marie, Ontario P6A 0B5 V0L.07 T: 705.942.1556 | F: 705.942.1444 | www.archhospice.ca | [email protected]