Northern Health Individual Volunteer Application Form

By submitting this application:

I confirm the information in my volunteer application is complete and true. I understand and agree that any omission or misrepresentation with respect to the information given may be cause for refusal or removal from volunteer placement. I understand a Ministry of Justice Criminal Record Check may be required for some positions. I authorize Northern Health Authority (NHA) to contact the references listed and give permission for these references to release relevant information requested.

I understand, and give NHA permission to keep a record of my confidential personal information. I understand that personal information on this form is collected, used and disclosed by NHA in accordance with the Freedom of Information and Protection of Privacy Act of BC (FOIPPA). I understand that NHA may engage service providers to host and manage this service on behalf of NHA. In such situations, NHA will take all reasonable steps to ensure my personal information is treated confidentially, is only used for the purposes described, and is stored securely. I understand this information may be disclosed to any party with legal and proper interest, and release the agency from any liability whatsoever for supplying such information. When NHA sends emails through Better Impact, a third party service based in the United States (US) is used. This means that my name and email address will be temporarily stored in the US for approximately 30 days. During this time, the information is subject to US laws and regulations.

If I have any questions about the collection, use and disclosure of my information, I can contact the NHA Information Privacy Office by email at privacy@northernhealth.ca. 

All volunteers must adhere to NHA's policies, including Confidentiality and Privacy and immunization requirements.

Please note: Incomplete applications will not be considered