Volunteer Application

If you have any questions, please contact our office to speak with a Volunteer Services Coordinator, 204-889-8525.

Volunteer Application Online Form

If you are human, leave this field blank.
After your training is completed, are you able to make a one year commitment of volunteering 1 to 4 hours a week? *
Yes
No
What days/times are you available? (Please note that at this time we are giving preference to day time Telephone Bereavement Volunteers) *
General Information
Name
Address *
Country
City
State
Zip code
Email *
For confidentiality reasons, all applicants must have a private email address (NOT to be shared with another person).
Phone *
Emergency Contact Name and Phone Number *
Language
Preferred Language:
Other Language:
Education
High School
Name of Institution:
Level of Education
Post Secondary
Name of Institution:
Level of Education
Other
Name of Institution:
Level of Education
Are you receiving credit for your volunteer work? If so, what are your required hours?
Employment
Employment Status
Employer 1
Last three places of Employment
Company Name / Employer:
Job Title
Start & end dates
Reason For Leaving
Employer 2
Last three places of Employment
Company Name / Employer:
Job Title
Start & end dates
Reason For Leaving
Employer 3
Last three places of Employment
Company Name / Employer:
Job Title
Start & end dates
Reason For Leaving
Volunteer Questions
Why do you want to volunteer with Palliative Manitoba?
Summarize your previous volunteer experience. Where did you volunteer? What did you do? What did you like about your previous experience? What did you dislike about it?
Health information
Please list any limitations, or health issues (includes allergies, back problems etc.) which may affect your ability to perform as a volunteer and that you wish to have taken into consideration when pursuing a volunteer placement.
Questions
Please check the areas of volunteer work you are interested in.
Volunteer Visiting Service - Weekly visits with individuals who have life limiting illness (up to 4 hours/week)
Telephone Bereavement - Weekly phone calls with a bereaved individual (1 hour/week)
Final Days Final Hours - Sit with individuals who are actively dying (3 hour shifts as required)
Memory Tree - Support grieving individuals (Shifts are 3 hours throughout the months of November and December each year)
Grief Seminars - Support participants in seminar (2 hours/month)
Grief Support Groups - Assist with facilitation of various grief support groups (as required)
Comments
1. Have you experienced any losses in your personal life? (Death, divorce, health issues, etc.) Please tell us about those losses.
2. What kind of experiences in your work the dying and bereaved would most likely upset you?
3. Is there a time in your life when you needed to turn to someone for help or support? (professional or otherwise)
4. Describe how it felt to approach this person.
5. What did you see as helpful?
6. Was there anything that was not helpful?
7. What do you feel are the strengths/skills that you bring to your volunteer work?
8. What do you feel are the weaknesses that you bring to your volunteer work?
References
References
Please list three references (Including Phone Numbers)—past or present employers, volunteer administrators, teachers, etc. One reference from a personal friend is acceptable (this does not include family).
*
I understand
Due to the sensitivity of the volunteer’s role with Palliative Manitoba, we screen our candidates, thoroughly. We understand that many of these questions are personal in nature, but we will NOT consider incomplete applications. You may contact our office if you have any questions or concerns.

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