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 | |


Name: __________________ _____ Phone #: _____

Name: ________________________ Phone #: _____

Junior Volunteer: (requires parental approval)

Parent/Guardian Name: _____________________________________Phone #:______________________

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