Please ensure that you have reviewed the infomation on Southlake Website -- www.southlakeregional.org Volunteering Pages before completing the volunteer application.
Please complete all areas of the application. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
Fields marked with an * asterisk are required fields. If you do not wish to submit your application, you may exit this form at any time by closing your browser. All information will be lost. Southlake communicates via email. Please make Southlake Regional Health Centre a Safe Sender in your email program settings.

General Volunteer Application

I am applying for:
Year Round Volunteering
I will make Southlake a Safe Sender. Southlake communicates via email please make us a safe sender in your email program settings or you may not recieve any correspondance from us. *
Personal Information
First Name*
Preferred name
Last Name*
Home Address
City
Province
Postal Code
Home Phone*
Work phone
Extension
Cell Phone
E-mail Address*
Please indicate if you are an adult or a student.
If you are an adult attending school, please choose university/college or high school.
Emergency Contact Information
Contact name
Relationship
Home Phone
Work Phone
Extension
Cell Phone
E-mail
Optional for Statistic Purposes Only
Age Group

How did you hear about volunteering at Southlake Regional Health Centre/Southlake Residential Care Village? (Check all that apply)
What is your reason(s) for volunteering?
(Check all that apply):
Other
Other

Experience
Employment Experience
I am currently:
Employed Full time
Employed Part time
Seeking Employment
Retired
Other
Please list current or most recent employment first
Company
Position
Year
Education
Are you currently attending school?
Yes
No
Recent Graduate
Name of School
Field of Study
Volunteer Experience
Organization
Position
Year
Skills & Special Requests
Skills
Languages Spoken in addition to English
Special requests/needs
Comments regarding special requests/needs
Availability

Please indicate ALL times you are available to volunteer
For most volunteer opportunities: You must commit to the same shift every week.
Monday
8 am to 12 pm
12 pm to 4 pm
4 pm to 7 pm
7 pm to 10 pm
Tuesday
8 am to 12 pm
12 pm to 4 pm
4 pm to 7 pm
7 pm to 10 pm
Wednesday
8 am to 12 pm
12 pm to 4 pm
4 pm to 7 pm
7 pm to 10 pm
Thursday
8 am to 12 pm
12 pm to 4 pm
4 pm to 7 pm
7 pm to 10 pm
Friday
8 am to 12 pm
12 pm to 4 pm
4 pm to 7 pm
7 pm to 10 pm
Saturday
8 am to 12 pm
12 pm to 4 pm
4 pm to 7 pm
7 pm to 10 pm
Sunday
8 am to 12 pm
12 pm to 4 pm
4 pm to 7 pm
7 pm to 10 pm
Other Times Available
Area of Interest
Please choose the Southlake location where you would prefer to volunteer:
Location Preference #1
Location Preference #2
Location Preference #3
Please choose type of volunteer support you are interested in providing:
Preference #1
Preference #2
If there is a specific department in which you would like to volunteer, please indicate:

I confirm that:
I am 16 years old or older*
I have provided true & accurate information on my application*
I must provide a clear Vulnerable Sector Police Check*
A clear Vulnerable Sector Police Check indicates that an individual does not have a criminal conviction for which a Pardon has not been received.
I understand that:
  • The personal information collected in this application will be used as part of the application screening process to evaluate my suitability for a volunteer position at Southlake Regional Health Centre/Southlake Residential Care Village.
  • My personal information will not be used or disclosed for purposes other than those for which it was collected, except with the appropriate consent or as required by law. Personal information will be retained only as long as necessary for the fulfillment of those purposes or as required by law pursuant to the Public Hospital Act and the Freedom of Information and Protection of Privacy Act (FIPPA).
    Southlake Regional Health Centre places high value on the protection of personal information in compliance with legislation.
  • By typing my name below, I confirm that I have read and understood the information above.*
    The Volunteer Resource Department screens all applications. Due to the fluctuations in our requirements for volunteers and the suitability of applicants, we cannot guarantee that every applicant will obtain a volunteer placement.

    Thank you for your interest in Volunteering at Southlake!