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Staff Only Area
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Volunteers
Opportunities

Application Form

= Denotes required field.

Personal Information
Last Name:
First Name:
Address:
 
Postal Code:
Phone: ( ) -
Are you in good health? Yes   
No

If no, please explain:
List Known Disabilities:
What languages do you speak?
Do you have a criminal record? Yes   
No

If yes, please explain:
Why do you want to volunteer at Donwood Manor?
Interests & Hobbies:
 
In Case of Emergency
Full Name:
Phone: ( ) -
Relationship:
 
Volunteer History
Facility:
Address:
 
Phone: ( ) -
Reason for Leaving:
 
Most Recent Employment History
Employer:
Position:
Address:
 
Phone: ( ) -
Supervisor:
Reason for Leaving:
 
Most Recent Education History
Institution/School: 1.
2.
Course: 1.
2.
Date Completed: 1.
2.
Achievement: 1.
2.
 
Which facility would you like to volunteer at? Personal Care Home
Elderly Persons Housing
Donwood South
Where Needed
Check Areas of Interest:
Friendly Visiting - reading, writing letters, reminiscing
Group Activities - bingo, bowling, games, tea parties
Outings - eating out, walks in summer, park outings
Resident Care - assist residents at meal time, accompanying to doctor’s appointments, comfort to the dying (PCH only)
Availability:
(Check all that apply.)
Monday: Morning
Afternoon
Evening
Tuesday: Morning
Afternoon
Evening
Wednesday: Morning
Afternoon
Evening
Thursday: Morning
Afternoon
Evening
Friday: Morning
Afternoon
Evening
Saturday: Morning
Afternoon
Evening
Sunday: Morning
Afternoon
Evening

References
NOTE: If you are a student, please give a current teacher for a reference.
Reference 1
Name:
Occupation:
Address:
 
Phone: ( ) -
Fax: ( ) -
Reference 2
Name:
Occupation:
Address:
 
Phone: ( ) -
Fax: ( ) -
Reference 3
Name:
Occupation:
Address:
 
Phone: ( ) -
Fax: ( ) -
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.