VOLUNTEER RESOURCES & ENGAGEMENT - ________________
(This form is to be completed by two references)
Volunteer Name: ___________________________________________ Date: ____________________________
Please answer the questions regarding this prospective volunteer’s personality, character and qualities for
volunteering at __________________________. All information you share helps us find the right volunteer
placement for this person. The volunteer listed will be supporting staff and/or providing a social support to the
residents/patients and their loved ones at __________________________.
1. Reliability, commitment
2. Trustworthy, hones/Integrity
3. Ability to communicate and
4. Interpersonal skills, working
5. Conflict resolution skills
7. Able to take direction
8. Good common sense
9. Good boundaries
10. Overall personality/character
PLEASE ANSWER THE FOLLOWING
Is the applicant a suitable candidate?
Does the applicant require supervision?
Do you feel the applicant’s other commitments may interfere
with his/her commitment to volunteering?
Any further comments:
Reference Name: ________________________Relatio
nship to the applicant:___________________________
Phone or email:___________________________ Reference Signature:__________________________________
Please note an original signature is required unless this form is filled out online and sent from the references’ personal email. The personal
email will be cons
idered a valid signature.
Please email, mail or drop off completed form to: Volunteer Resources & Engagement, Attention: RJH Intake
Mail/drop:________________________________________________________, _____________, BC, ________
Your reference is important and appreciated. Thank you.
Royal Jubilee Hospital, 1952 Bay St. Royal Block 453A