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I certify that all information on this application is true and I give permission for North Hamilton Community Health Centre (NHCHC) to contact the above references. By signing below you give NHCHC staff permission communicate with you through the contact information listed above. Please note that NHCHC will not share your information outside of the Health Centre without your permission.



Your Information

Emergency Contact

Where did you hear About Us?

Please complete with full names and addresses, two people who know you well enough to evaluate your qualifications as a volunteer. Include at least one previous and/or present employer, if applicable:

Reference 1

Reference 2