Essay about Volunteer: Mary and St. Joseph Health

Submitted By loco134567
Words: 549
Pages: 3

Volunteer Application Form

Step One: Complete & Return this Form

High School College Student Adult (Junior Volunteer 14 – 17 yrs old)

Date: ___________________

____________________ _____
Last Name (please print clearly First Name Middle Initial
1446 ____ _________________
Home Address City Zip Code _______________________
Phone Number Cell Number ________ ___________
Date of Birth Social Security Number ________ ___________
E-Mail address (please print clearly) _________ _____
Emergency Contact Name Address City Zip Code ___ ________________________
Phone Number Relationship

Have you ever been convicted of a misdemeanor or felony? Yes No Do you have any charges pending against you that are unresolved? Yes No If yes, state circumstances, place(s) date(s) _________________

_________________________________________________________________________________________

What days and times are you available to volunteer? (please check all that apply):

Monday Tuesday Wednesday Thursday Friday Saturday Sunday am pm am pm am pm am pm am pm am pm am pm

Please check your areas of interest: (Note: positions assigned upon availability)
| Clerical / Office (please indicate areas of skill): | Shuttle Service ( you will need to obtain the following): |
|______ Microsoft Office ______ typing speed (wpm) |current DMV print-out - valid CA driving license |
| Front Desk Receptionist | Gift Shop | Recovery Room | Surgery Desk |
| Patient Care Ambassador | Out-Patient Services | Junior Volunteer Program | |

References:

Name: __________________ _____ Phone #: _____

Name: ________________________ Phone #: _____

Junior Volunteer: (requires parental approval)

Parent/Guardian Name: _____________________________________Phone #:______________________

Address________________________________________________________________________________
Parent/Guardian Signature: ___________________________ Date ___________

The above information is accurate to the best of my knowledge

Signature: ______ Date: ___

1) Are you currently seeking employment? Yes No

2) Do you currently work or attend college? Yes No

3) Junior volunteers: High School Attending ______ Grad. Year: _________

4) Are you willing and able to commit to a regularly scheduled 3-5 hour shift each week? Yes No

5) Please share with us why you would like to volunteer at St. Joseph Health, St. Mary
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

6) What expectations do you have by volunteering at St. Joseph Health, St. Mary?
________________________________________________________________________________________________________________________________________________________________

7) Do you have limitations, handicaps or health conditions that should be taken into consideration before…