479	*	Please select the site(s) you are interest in volunteering at.	Clinton Site  St. Marys Site  Seaforth Site	3	1
477		Please note: Due to the large volume of applicants to the Stratford Site we are currently experiencing a wait list and have removed Stratford as an option until further notice. We thank you for your interest and patience!			7
482					7
27	*	Last Name:		1	1
28	*	First Name:		1	1
29	*	Address:		1	1
31	*	Telephone #:		1	1
32	*	E-mail address:		1	1
34		Contact Person:		1
35		Telephone #:		1
36		Relationship:		1
37		Address:		1
38		How did you become aware of the Volunteer Program at the Hospital?		5
39		Briefly explain your interest in becoming a volunteer:		5
500					7
484		Employment History:			7
40		Are you currently Employed?	Yes - Full-time Yes - Part-time No - Retired Not employed	2
42		Name of Employer:		1
43		Phone #:		1
44		Occupation:		1
45		Hours / Day worked:		1
502					7
486		Education History:			7
46		What is your level of education/training?		1
47		Are you currently enrolled in an educational course / program	Yes No	2
52		If yes, please explain:		5
504					7
488		Volunteer Experience:			7
50		Are you currently a volunteer for another agency and/or have you volunteered in the past?	Yes No	2
506					7
49		If yes, please list agencies and describe volunteer position(s).		5
510					7
494		Availability:			7
54		What is your Availability?		5
57		Are you away in the summer or winter?	Yes - in the summer  Yes - in the winter  No	3
59		Could you "job share"	Yes  No	3
512					7
490		General Information:			7
53		Please indicate your hobbies and general interests.		5
56		Do you have skills in any of the following areas?	Computer  Cash Register  Retail  Banking  Other	3
492		If you chose "other" please identify the skill.		1
514					7
496		Additional Information:			7
62		Do you speak any other languages?		1
64		Do you play an instrument?		1
66		Do you have any other abilities you would like us to be aware of?		1
516					7
498		Volunteer Opportunities - Area(s) of Interest:			7
60		Please choose area(s) of interest:	Blood Donor Clinic  Chemotherapy  Coffee Shop  Complex Continuing Care and Rehabilitation Program  Craft Program  Day Surgery  Emergency Department  G.A.G.S. (clowning)  Gift Shop  H.E.L.P. Lottery  Information Desk  Laboratory  Medical Imaging  Mental Health  Ontario Breast Screening Program  Orthopedic Clinic  Palliative Care  Patient Registration  Physiotherapy  Surgical Ambulatory Care	3