Volunteer Application Form

Personal Information

Name:
Address:
Postal Code:
Phone:
Why do you want to volunteer at Donwood Manor?
Interests & Hobbies:

In Case of Emergency

Emergency Full Name:*
Emergency Phone:*
Relationship*

Volunteer History

Facility:*
Facility Address:*
Facility Phone:*
Reason for Leaving:*

Most Recent Employment History

Employer:*
Position:*
Employment Address:*
Employment Phone:*
Employment Supervisor:*
Employment Reason for Leaving:*

Most Recent Education History

Education 1

Institution/School*
Course:*
Education Phone:
Achievement*

Education 2

Institution/School(2)*
Course:(2)*
Education Phone:(2)
Achievement(2)*

Which facility would you like to volunteer at?
Check Areas of Interest:

Availability (check all that apply)

Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Sunday:

References

NOTE: If you are a student, please give a current teacher for a reference.

Reference 1

Reference Name:*
Reference Occupation:*
Reference Address:*
Reference Phone:*
Reference Fax:

Reference 2

Reference Name:(2)*
Reference Occupation:(2)*
Reference Phone:(2)*
Reference Fax:(2)

Reference 3

Reference Name:(3)*
Reference Occupation:(3)*
Reference Address:(3)*
Reference Phone:(3)*
Reference Fax:(3)

I authorize Donwood Manor to check the above listed references.

I understand that all information concerning residents, physicians, volunteers and other employees is to be held in the strictest confidence and that breach of Donwood Manor’s confidentiality policy may be grounds for dismissal.