Welcome to Interior Healths Volunteer Portal

Volunteer Application

Volunteer Application


Personal Information
Application Entry Date
First Name
MI
Last Name
Suffix
Mailing dear
prefered location
Home Address
City
State
Zip Code
Home Phone
Cell Phone
Work phone
E-mail Address
Person Type
DOB
Gender

Kiosk User Information
Kiosk disabled
Kiosk user ID
Web/kiosk password
Web/kiosk password hint

Emergency Contact Information
Contact name
Address
City
State
Zip Code
Home Phone
Cell Phone
Work Phone
E-mail

Medical Information
https://justice.gov.bc.ca/eCRC/
Wheelchair/requires handicap access
Medical alert
Job preferences (as checklist)
CRC ID NUmber
References; please provide contact information for 2 people
References
References # 2