Friends of Sgh Volunteer Application Form

(CD-CCD-A01)

FRIENDS OF SGH VOLUNTEER APPLICATION FORM

Thank you for your interest in volunteering at SingaporeGeneralHospital. All information provided in this form will be treated in strict confidence. Please send completed form via Fax: 6271 8786 or mail to SGH, 168 Jalan Bukit Merah, #13-01 Surbana One, Singapore 150168 (Attn: Ms Mumtaj Ibrahim).

Note: All Secondary, JC studentsawaiting their final-year resultsneed not complete this application form. Instead, please send an email to to enable us to review your request and respond accordingly.

1. PERSONAL DATA

Full Name:

NRIC / FIN No:Nationality:

Age: Date of Birth:Gender:

Address:

Tel (H): Tel (O): HP:

Email:

VOCATION:

Working Adult - Occupation: Company:

Retiree - Previous Occupation:

Others (please specify):

2. EMERGENCY CONTACT

Name of contact: Relationship:

Tel (H): Tel (O): HP:

3. LANGUAGE PROFICIENCY

Languages spoken: (please tick)

 English  Mandarin  Malay  Tamil  Dialects / Others: (please specify):

4. HIGHEST EDUCATION LEVEL

 Secondary  College  Polytechnic  University/Others: (please specify):

5. SKILLS

Please list any special skills which you can share during your voluntary stint at SGH.

Please tick any of volunteer programme/programmes that you are interested in and the time of availability.

MON / TUE / WED / THUR / FRI / SAT
Guider’s Programme
- Assist elderly and/or dialect speaking patients
at various Clinics, A&E and other service centres.
Programme available only from Mon – Fri
[ ] Morning session : 9am – 1pm
[ ] Afternoon session : 1pm – 5pm / NA
Retail Cart
-Assist to sell gifts/bags/souvenirs at the Retail Cart to raise funds for needy patients.
Programme available only on Mon – Fri, 10am to 2pm / NA
Merry Melodies
- Entertain patients with performances (musical instruments, magic shows) at patients’ bedside. Programme available on Mon – Fri, 10am–5pm for 1-2 hours. / NA
Arts & Craft Programme
- Engage patients in simple handicraft/games (eg: chess/cards) at the wards. Volunteers interested are encouraged to form a team of between 12-20 members. Available on Sat, between 3pm – 5pm. / NA / NA / NA / NA / NA
Administrative & Ad-hoc Programmes / NA

Please tick your estimated duration of voluntary service:

3 months6months More than one year  Others (please specify):

How did you come to know of the volunteer programmes at SGH?

 SGH Website  Friends Patients  Others (please specify):

6. BACKGROUND CHECKS

We consider the safety and security of our patients to be of utmost importance.

i) Have you ever been convicted in the court of law in any country?

 Yes, please specify:

 No

ii) Have you ever been treated for any psychiatric disorders?

 Yes, please specify:

 No

I understand that if I falsify any information or omit any materials facts, termination of volunteer assignment may result.

______

Applicant’s Signature Date

For official use
Interviewed by / Interview date
Accepted /  Yes  No / Remarks