Volunteer Application

Thank you for your interest in volunteering with Palliative Manitoba. We accept applications on an ongoing basis for the next available course.

Individuals who wish to volunteer for Palliative Manitoba must first complete the Volunteer Application Form (below).  Individuals that fulfill the screening requirements will be invited to attend the ten-week Compassionate Care Course.  Once selected, volunteers are asked to consent to a minimum one-year post-course commitment.

You can download, print and complete the application manually or submit via the online form below.

Volunteer Application Form

Due to the vulnerable nature of the individuals that we support, all potential volunteer candidates are thoroughly screened through interviews and police record checks.

Volunteers are also required to take a 10 week Compassionate Care Course (25 hours of interactive classroom in either the spring or fall session) in addition to an online Personal Health Information Act (PHIA) training component (approx. 30 minutes).

Depending on when we receive an application this process can take up to 9 months before a volunteer is ready to be matched in the community. We ask that individuals be prepared to make a minimum commitment of one year post-training.

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 *

CountryUnited States (US)United Kingdom (UK)CanadaAustralia---AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAmerican SamoaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraÇaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqRepublic of IrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Martin (Dutch part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaWestern SamoaYemenZambiaZimbabwe

City

StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)American SamoaGuamNorthern Mariana IslandsPuerto RicoUS Minor Outlying IslandsUS Virgin Islands

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

Employed Full-TimeEmployed Part-TimeUnEmployedRetired

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).

Submit