Volunteers Make a Difference!

Name:(Required)

First Middle Last

Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone:(Required)

Email address:

Date of birth:(Required)

Education:(Required)

Check all that apply

High School

College

Post-Graduate

Work Status:(Required)

Employed

Retired

Unemployed

Current Place of Employment:(Required)

Employer Phone:(Required)

Volunteer Availability (time):(Required)

Morning

Afternoon

Volunteer Availability (days):(Required)

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Have you, since the age of 18, plead guilty or been convicted of a misdemeanor or felony charge, including any suspended imposition or execution of sentence?(Required)

Yes

Please list 2 personal references (not related):

Reference 1 Name:(Required)

Reference 1 Phone:(Required)

Reference 2 Name:(Required)

Reference 2 Phone:(Required)

Referred by / reason for choosing to volunteer with Saint Francis:(Required)

Would you like information about our Auxiliary?(Required)

Yes

Emergency contact information:

Emergency Contact Name:(Required)

Emergency Contact Phone:(Required)

Emergency Contact Relationship:(Required)

As a volunteer, I:

Agree to complete the volunteer orientation and train until I am competent to perform the required duties
Agree to complete an ANNUAL education review and employee health requirements as well as any additional service-specific training that may be deemed necessary
Agree to comply with all the rules and regulations of Saint Francis Medical Center and to uphold the bylaws of Volunteer Services
Understand that I may be dismissed from my duties for willful wrongdoing or negligence and/or performing duties outside of my service guidelines
Agree to call Volunteer Services as soon as possible when I have scheduling changes
Agree to accept assignment to a new service area if absent for an extended period of time

I confirm that the information provided in this application is true in all aspects, without any willful omissions. I understand that if this application is false in any way I will be dismissed without notice regardless of when the false information is discovered.

Phone

This field is for validation purposes and should be left unchanged.

Perks

Requirements

Questions?

Application

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