Friends of CGH - Application Form

(Regular Volunteer)

Note : Please refer to the Volunteer Guidelines before completing this application
Applicants must be at least 18 years old
Please write legibly
We will also need to photocopy your NRIC/Passport for our files

About Yourself:
Name (Mr / Mrs / Mdm / Ms)
(underline Surname)

DOB Religion

NRIC Nationality

Highest
Occupation
Qualification

(Mobile):
Telephone Address
(Home):

Email S( )

In an emergency, you may contact my parent / spouse / _____________

Name of contact person:_______________________________________Contact no:_____________________________

I can speak English Mandarin Malay Tamil Dialects ___________________

Language Proficiency
I can write English Mandarin Malay Tamil Others_____________________

About Your Volunteer and Work Experiences (Starting from your most recent experience)

1) Name of Employer Period

Job Scope and Position

Reason for Leaving

2) Name of Employer Period

Job Scope and Position

Reason for Leaving

3) Name of Employer Period

Job Scope and Position

Reason for Leaving

FOCGH/appl/2014/1
Volunteer History

1) Organization Period

Job Scope and Position

Reason for Leaving

2) Organization Period

Job Scope and Position

Reason for Leaving

Volunteering at CGH

Commencement Weekly Monthly

Frequency Fortnightly Ad Hoc Basis
Date

Mon Tue Wed Thu Fri

Hobbies and Interests Day(s) / Time Sat AM Sat PM

Time: ______________________________
(min 2 hours, 10am to 5.30pm)

What do you hope to gain from being a volunteer?

_____________________________________________________________________________________________________________

Charity Sale (HomeCare Assist)

Areas of Volunteer
Admin/Staff Support (Medical Social Services,
Activities Event Support (Corporate Affairs) & Corporate Affairs)

(You may tick more than 1 Patient Support Others: _____________________________

box) (For Long term volunteer)

Other Information (please answer the following questions)

1. Have you ever suffered or are you suffering from any medical conditions, illness, disease, mental illness or physical impairment?
* Yes / No
2. Have you ever been convicted in a court of law in any country? * Yes / No

3. Have you ever been detained by the police or any government bodies (other than traffic violations or misdemeanours) * Yes / No

I confirm that the information provided on this application is true and complete.
I also agree to abide by the Volunteer Service Guidelines and all CGHs policies and procedures.

Signature Date