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Ian Anderson House
Residential Hospice serving Mississauga and Halton since 1997
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Ian Anderson House
Volunteer Application Form
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4
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Applicant Contact Information
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Home Phone
*
Business/Cell Phone
Email
*
Preferred method of contact
*
Home Phone
Business/Cell Phone
Email
Employment Information
Name of Employer (company)
*
Email
Fax
May we call you at work?
*
Yes
No
Are you at least 21 years old?
*
Yes
No
Application Questions & Availability
In order for us to get to know you better, please read the following questions and write your responses in the indicated space.
How did you hear about Ian Anderson House?
*
Why are you interested in applying as a volunteer with Ian Anderson House?
*
Do you have any specific skills or interests which you feel would be of benefit to the House? (i.e. Office work, fundraising, gardening or maintenance work)
*
Please indicate the days and hours you will most likely be available.
*
Please also indicate below approximately how many hours a week or month you would prefer
*
Do you speak any languages other than English? If yes, please specify
*
Please share your previous or current volunteer experience.
*
Are there any restrictions/limitations or health concerns that we may need to be aware of?
*
Is there anything else you would like to add to the above?
*
Screening Agreement
*
By checking this box, I agree to the following:
To maintain the integrity of IAH and for the protection of our residents, a screening process will include an interview, contacting your references and a required criminal reference check. All information received in the course of the application procedure will be kept strictly confidential and be used solely for the purposes of determining the candidate’s ability to fulfill the responsibilities of an IAH volunteer. All personal information once reviewed becomes the sole property of IAH. Note: IAH is under no obligation to accept a volunteer for volunteer work and reserves the right to terminate the volunteer at any given time.
Reference 1
Please provide the names, phone numbers and full addresses of 2 people who we may contact for references excluding relatives. (i.e. Employer, volunteer agency, clergy, doctor, friend)
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
*
Relationship to you:
*
Reference 2
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
*
Relationship to you:
*
Reference Agreement
*
I have applied as a volunteer with Ian Anderson House (IAH) and I consent to IAH contacting the above named references.
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