Volunteer application form. Full name Gender Female Male Gender Enter other… (Optional) Date of birth Occupation Phone number (Optional) Email address Post address (New Zealand) How did you hear about us? (Optional) Facebook/social media Radio Visit to hospital Google search/website A letter in the post Email A door knocker Phone call Friends or family Other Enter other… (Optional) Job listing name/number (if applicable) (Optional) Emergency contact name Emergency contact relation to you Please tell us where you would like to volunteer Wellington Hospital Kenepuru Hospital Hutt Hospital Days you are available Monday Tuesday Wednesday Thursday Friday Saturday (Wellington only) Sunday (Wellington only) Times you are available 9am - 12pm 12 - 3pm 3 - 6pm (Wellington only) 6 - 9pm (Wellington only) Special interests, hobbies and memberships Other volunteer experience Any health problems / physical limitations which might limit your ability to work as a volunteer References Reference one Please provide referees that are outside your immediate family Full name Email Phone Capacity in which you know this reference Reference two Full name (Optional) Email Phone Capacity in which you know this reference Minors who are 17–18 may volunteer with parent/caregiver consent (Optional) I am 17/18 and require parent/caregiver consent Parent/caregiver name (Optional) Parent/caregiver contact number (Optional) Declaration (Optional) I understand that my details will be forwarded for a police check and I will have to undergo a police check. I understand the first month will be a probationary period. I understand I will be required to agree to abide by the Foundation and Hospitals policies and principles relating to volunteers, before commencing work as a volunteer. Leave this field blank (Optional)
