You must have JavaScript enabled to use this form. Zone * Acadie-Bathurst Facility * Personal information Surname * Name * E-mail * Telephone * Work * Cellular * Address * City * Province * - Select -New BrunswickNova ScotiaPrince Edward IslandNewfoundland and LabradorQuébecOntarioManitobaSaskatchewanAlbertaBritish ColumbiaYukonNorthwest TerritoriesNunavut Postal Code * In case of emergency, please notify Name * Telephone * Relationship * Languages Spoken * French English Other Written * French English Other Other, specify Experience Profession * Unemployed Post-secondary student High school student Worker Retired Current job * Training * Work experience * Hobbies, interests * Other relevant information Have you ever volunteered in any facility within Vitalité Health Network? * No Yes Specify Why do you want to volunteer? * You can attach your resumé to this application. Volunteer opportunitiesWhich volunteer programs interest you most? You can view the list of programs at: http://www.vitalitenb.ca/en/volunteers (Please list in order of preference) : 1 * 2 * 3 * Special Skills Please indicate whether you have any special skills that you would be willing to offer as a volunteer * Knitting Sewing Arts and crafts Computer Musical instrument or singing Painting Woodworking Esthetics Hairdresser Other Other ReferencesPlease provide the name, complete address and e-mail address (when possible) of three persons who know you well and could provide a reference (individuals to whom you are not related and who have known you for at least two years).1 Name * Telephone * Address * Postal code * Relationship * E-mail * Communication * French English 2 Name * Telephone * Address * Postal code * Relationship * E-mail * Communication * French English 3 Name * Telephone * Address * Postal code * Relationship * E-mail * Communication * French English AvailabilityPlease indicate your availability below.AM Sunday * Monday * Tuesday * Wednesday * Thursday * Friday * Saturday * PM Sunday * Monday * Tuesday * Wednesday * Thursday * Friday * Saturday * Evening Sunday * Monday * Tuesday * Wednesday * Thursday * Friday * Saturday * Can you, for the most part, volunteer the same day and time once a week? * Yes No, please explain Explain Have you ever been convicted of a crime for which you have not received a full pardon? * Yes No If yes, explain * I certify that statements made in this application are true and correct. I certify that statements made in this application are true and correct. Leave this field blank