Volunteer at Roger Neilson House!

Thank you for your interest in volunteering with Roger Neilson House. Volunteers play a vital role in the delivery of our services. All volunteer applications are reviewed with consideration of current volunteer opportunities.

Please note: This form will remain on file at Roger Neilson House. All volunteer information and files are kept confidential and are only available to authorized hospice staff such as supervisors of volunteers and trained office help volunteers who have signed a confidentiality agreement. Roger Neilson House is committed to providing appropriate protection for your personal data. Data collected on this volunteer application form may be used by Roger Neilson House to consider your application for volunteer engagement, and to communicate with you with respect to your application.

Once you've completed and submitted the application form, you will receive an email confirmation of your application and be presented with further instructions and information.

Volunteer Application Form - Roger Neilson House

SUBMIT YOUR CV / RÉSUMÉ
We'd like to get to know you better, don't forget to send your CV / résumé to volunteers@rogerneilsonhouse.ca
PERSONAL INFORMATION
First name
Middle name
Family/last name
Date of birth (MM/DD/YY)
Gender
Language
Additional languages
Address Line 1
Address Line 2
City
Province
Postal code
E-mail
Mobile phone
Home phone
Work phone
Medical notes
Diet alert/restrictions
Wheelchair/requires handicap access
EMERGENCY CONTACTS
Contact 1 name
Relationship
Address
City
Mobile phone
Home phone
Work phone
E-mail

Contact 2 name
Address
City
Mobile phone
Home phone
Work phone
E-mail

Family doctor name
Work phone
BACKGROUND
What has motivated you to volunteer at Roger Neilson House at this time?
Volunteer source
Are you presently volunteering with another organization?
If yes, where?
Do you have previous experience as a volunteer?
If yes, please expand.
Do you have experience working with children? If yes, in what capacity?
What, if any, experience do you have working with children who are physically, mentally, or developmentally challenged?
What professional or other experience have you had that will assist you in the role for which you are applying?
What hobbies, skills, interests, or credentials do you have that might benefit you in your volunteer role? I.e. first aid training.
Select any of the following you have had:
DESIRED VOLUNTEER ROLE(S)
Primary
Skills (select all)
Authorization and Consent:

I give permission to Roger Neilson House to collect personal information appropriate to the position I'm applying for and to verify the character references I have listed here. I understand and agree that to the best of my knowledge the information I have provided is complete and accurate in every respect.

As an organization, we value the health and safety of our patients, families and staff. In order to achieve a high standard of health and safety your opportunity to volunteer at Roger Neilson House would be conditional upon satisfactory confirmation of tuberculosis testing and yearly flu immunization.

I submit this application for a volunteer position with Roger Neilson House. I understand I must participate in a volunteer information session prior to an interview. I understand that I may not be accepted for an interview. If I am interviewed, I understand that I may not be accepted as a volunteer. I understand that a successful reference check and a police records check for the vulnerable sector form part of the screening process in becoming a volunteer. I agree that Roger Neilson House may at any time, for just cause, decide to terminate a volunteer's engagement with Roger Neilson House.
I have read and understood the above authorization and consent statements.
I agree with the above authorization and consent statements and permit Roger Neilson House to proceed with their volunteer screeing and selection process.
TUBERCULOSIS SCREENING
Have you spent a total of three (3) consecutive months or more during the past five (5) years in any First Nations community(ies) or any country(ies), collectively or uniquely, listed below? (Applies if you have emmigrated from, and/or visited a listed country)
Yes
No
First Nations Communities in:Alberta; British Columbia; Manitoba; Northern Ontario; Northwest Territories; Nunavut; Quebec; Saskatchewan; and Yukon.

Afghanistan; Algeria; Angola (inc. Zaire); Argentina; Armenia; Azerbaijan; Bahamas; Bahrain; Bangladesh; Belarus; Belize; Benin; Bhutan; Bolivia; Bosnia and Herzegovina; Botswana; Brazil; Brunei Durassalam; Bulgaria; Burkina Faso; Burma (Mayanmar); Burundi; Cambodia; Cameroon; Cape verde;Central African Republic; Chad; China; China (inc. Hong Kong; Macao); Colombia; Comoros; Congo; Congo, democratic Republic; Côte d'Ivoire; Croatia; Djibouti; Dominican Republic; East Timor; Ecuador; El SalvadorAfghanistan; Algeria; Angola (Zaire); Argentina; Armenia; Azerbaijan; Bahamas; Bahrain; Bangladesh; Belarus; Belize; Benin; Bhutan; Bolivia; Bosnia and Herzegovina; Botswana; Brazil; Brunei Darussalam; Bulgaria; Burkina Faso; Burma (Myanmar); Burundi; Cambodia; Cameroon; Cape Verde; Central African Republic; Chad; China; China (Hong Kong; Macao); Colombia; Comoros; Congo; Congo, democratic Republic; Côte d'Ivoire; Croatia; Djibouti; Dominican Republic; East Timor (Timor Leste); Ecuador; El Salvador; Equatorial Guinea; Eritrea; Estonia; Ethiopia; French Guiana (Guyana; Guiana); Gabon; Gambia; Georgia; Ghana; Greenland; Guam; Guatemala; Guiana (Guyana; French Guiana); Guinea; Guinea-Bissau; Guyana (Guiana; French Guiana); Haiti; Honduras; Hong Kong (China; Macao); India; Indonesia; Iraq; Kazakhstan; Kenya; Kiribati; Korea - North; Korea - South; Kyrgyzstan; Lao / Laos; Latvia; Lesotho; Liberia; Lithuania; Macao (China; Hong Kong); Macedonia; Madagascar; Malawi; Malaysia; Maldives; Mali; Marshall Islands; Mauritania; Mauritius; Mexico; Micronesia; Moldova; Mongolia; Morocco; Mozambique; Myanmar (Burma); Namibia; Nepal; New Caledonia; Nicaragua; Niger; Nigeria; Northern Mariana Islands; Pakistan; Palau; Panama; Papua New Guinea; Paraguay; Peru; Philippines; Portugal; Qatar; Romania; Russia; Rwanda; Sao Tome and Principe; Saudi Arabia; Senegal; Serbia and Montenegro; Seychelles; Sierra Leone; Singapore; Solomon Islands; Somalia; South Africa; Sri Lanka; Sudan; Suriname; Swaziland; Syrian Arab Republic; Taiwan; Tajikistan; Tanzania; Thailand; Timor Leste (East Timor); Togo; Turkmenistan; Uganda; Ukraine; Uzbekistan; Vanuatu; Venezuela; Vietnam; Yemen; Zaire (Angola); Zambia; and Zimbabwe.