Volunteer Application
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Volunteer Application

 

Volunteer Application

* Required Field
*Last Name:
*First Name:
Nickname (optional):
Address:
City:
Zip:
*Home Phone:
*Email:  
Business Phone:
*Cell/Pager:
*Date of Birth (MM/DD/YYYY) if over 18:
   
If under 18, please include your age:
Emergency Contact Information:
Name:
Day Phone:
Evening Phone:
Describe your employment experience, if any. Please list employers, dates, and describe duties.
Describe previous volunteer experience, if any. Please list organization, date, and describe service.
Do you have any friends who work or volunteer for SVMH? Please list name(s) and relationship(s).
Please list your hobbies, interests, and memberships. (You may omit those which indicate your race, religious creed, color, national origin, ancestry, age, gender, physical or mental impairment, or medical condition)
Please check areas in which you have had training or experience:




Would you be able to perform the following tasks (with or without accommodation): pushing patients in wheelchairs, standing at a cash register, answering phones, assisting with patient needs, i.e. refilling water, watering, plants.


If No, please explain.
Why are you interested in volunteering?
Desirable times for you to volunteer:

Day of Week:

 

Time of day:

Do you have any activities which could interfere with a regularly scheduled assignment?
Education - Are you currently enrolled in an educational program?


If Yes, which school.

When will you graduate? Enter Year.

TB Screening is required for all hospital volunteers initially and annually thereafter. There is no charge for this test, which is administered by the SVMHS Employee Health Nurse. If you have a history of positive skin test results, Employee Health will request a baseline chest X-ray and annual "sign and symptom review" questionnaire.

If under 18, please click here to complete school and parent contact information and print a parental consent

For Spiritual Care Volunteers, please click here to complete congregation information and print pastor referral

For Pet Therapy Volunteers, please click here to complete supplemental questionnaire

Submit Application