I confirm that I can commit 9 months to the volunteer program.
Please note that time(s) and placement(s) selected may not be available to you upon acceptance into the program.

Personal Information

Emergency Contact

Work Experience (current or past)

Volunteer Experience (current or past)

Reference Information

References: Upon acceptance, we will be asking these individuals to complete a reference on your behalf. Please select a referee if they have known you for at least one year (preference) in a professional manner (employer, supervisor, teacher, coach, etc.). We do not accept references from family, friends of family, personal friends or fellow students.
Reference 1
Reference 2


Times are an approximate. Actual shift times will vary based on placement offered.
Please indicate ALL the day(s) and time(s) you are available to volunteer. After the interview, should you be selected, we will choose one or two shifts.


Please attach your resume here:


I understand that all volunteers must agree to provide a Vulnerable Sector Check and a Health Screening Check upon acceptance into the program.
I understand that Mackenzie Health receives applications far in excess of the placements we have available and regrettably are not able to offer all candidates a placement.
I have carefully considered my ability to commit to a position before submitting this application. I understand that the hospital reserves the right to release volunteers from their placement if they are unable to fulfill the duties or the time commitment required by the placement.
I acknowledge and understand that the above information is true and complete to the best of my knowledge. I understand that a false statement may disqualify me or cause my dismissal.
I agree to receive electronic communication from Mackenzie Health and I give permission for the information I have provided on this form to be given to Mackenzie Health staff and volunteers in connection with a potential volunteer placement at the hospital. Mackenzie Health communicates via email so please make us a safe sender to ensure you recieve any correspondance from us.