Trillium Health Centre Foundation
Trillium Health Centre Foundation
Trillium Health Centre
Volunteer Application Form 
Note: Items marked with an asterisk * are mandatory.  
 
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Site Preference: (Please check one)
   Trillium - Missisauga | Trillium - West Toronto
      100 Queensway West
(corner of Hurontario and Queensway)
  		    150 Sherway Drive
(across from Sherway Gardens Shopping Centre)
 
 
 
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Volunteer Program of Interest:(Please check one)
Adult   High School Student Program      University and College Students 		 
 
Demographics:(Please check one)
16 to 17   18 to 25   26 to 35   36 to 45   46 to 55   56 to 64   65+		  
   
General Information		      
 
Date of Birth: (Optional)		    

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Title:		    

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Sex:		    
Female | Male		  

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First Name:		    
 
Middle Initials:		    

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Last Name:		    
 
Apartment/Unit #:		    

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Address:		    

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City:		    

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Province:     * Postal Code: 		 

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Home Phone:		   Area Code: Number:  


Business Phone:		   Area Code: Number:  
 
Pager/Cell:		   Area Code: Number:  
 
E-mail Address:  		   
 
  
Languages Spoken other than English:
    
  
     
 
Emergency Notification/Guardian Information		  

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Name:  		   

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Home Phone:		   Area Code: Number:  
 
Business Phone:		   Area Code: Number:  
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Do you have health concerns/special needs which may impact your ability to perform your volunteer role?   Yes   No 		 
  If yes, please explain:    
 
Are you legally entitled to work in Canada ?   Yes   No 		 
  If no, please explain:    
     
 
Work and Education History		  

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Are you currently employed? Yes No | Full-time Part-time		  
 
Company:		    
 
Job Title:		    
   
Transferable Skills:		    
  

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Are you currently a student? Yes No | Full-time Part-time		  
 
High School/College/University: 		   
 
Program/Grade Level:		    
 
Certification/Diploma/Degrees obtained:		    
     
 


Volunteer Experience

  

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Have you had previous volunteer experience? Yes   No 		 
 
Organization(s):		    
  
 
Description of tasks/accomplishments:		    
  
 
What did you enjoy most about your volunteer experience?		    
  
     
 
What are your
reasons for volunteering?		    
Desire to help others
Experience in health care career
Interest in community involvement
Workfare/Mandated Community Service
School Graduation Requirement
Other (please describe)

  		 
 
How did you hear about volunteering at Trillium?		    
Newspaper
Television
Volunteer Referral
Hospital Staff Referral
Family/Friend Referral
School
Coop
Volunteer Centre
Website
Other (please describe)

  		 
 


Interest and Availability

  
 
Please check all that you are interested in:		    
Patient Care
Administrative/Clerical
Retail
Way Finding/Hospitality
Other (please describe)

  		 
     
 


Time Availability Check the appropriate box(es):
 

 
 
Shift\Day Monday Tuesday Wednesday Thursday Friday Saturday Sunday
A.M. (9-12pm)
P.M. (12-4pm)
Evening (4-6pm)
Late (6-10pm)

 
 


Trillium Volunteer Process

  • Due to the volume of applications received we are not able to contact or place everyone who applies.
  • Appropriate fit, interests, flexible availability and references are the key criteria we use when selecting applicants
  • The commitment is a minimum of 6 months or 50 hours of service
  • Applicants who are successful will be contacted by email or phone to arrange for an interview.
  • If you have not been invited for an interview within a three month period please re-submit your application.
  • All applicants must submit or be in the process of submitting two completed reference forms.
  • Trillium also requires that all volunteers complete a two step TB test or chest X-ray as well as have verification for Mumps, Measles, Rubella, and Varicella (chicken pox) immunization. (Forms can be downloaded from the website)

It is at the discretion of the applicant to complete these steps to be considered for a position. Completing these steps does not guarantee placement.

  

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I hereby agree that I have read and understood the above information. All personal and background information provided is true and accurate.