Volunteer Application

Volunteering
Thank you for your interest in volunteering at CMC. Below please find our application, additional requirements can be found here: Become a Volunteer. Please notice that the (*) asterisked items are required fields.

Personal Information

Title:
*
*
*
month/day/year

Address Information

*
*
*
*
Is anyone else at this address already a volunteer at CMC:
Are you currently employed at CMC: *
Have you volunteered for this organization before: *

Contact Information

*
I prefer to receive calls at:
Do you have any medical conditions that would affect your ability to perform your volunteer duties, or that the volunteer office should be aware of:
Have you ever been convicted of a felony or misdemeanor or narcotics violation? Arrests or charges that have been expunged need not be disclosed. A conviction will not necessarily disqualify an applicant for volunteer service.:

Education

High School Graduate:
College/Graduate School Degree:

Employment Information

I am: *

Work Schedule Information

 

General Information

How did you find out about our volunteer program:

If referred by someone, please enter:

Relation:
General area in which you would prefer to serve:

Commitment

Regarding the length of your commitment to volunteer service:

Are you able to make a minimum commitment of one 3 to 4 hour volunteer shift per week for six consecutive months:

Please note: After your initial commitment is fulfilled, in order to maintain “active” volunteer status you must continue to volunteer a minimum of 50 hours of service per year.

Availability

Please check all the times that you might be available for a volunteer assignment.

Sunday:
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:

Other Information


References

Please print, sign and mail this reference form to two personal references (other than relatives), who have known you for more than one year and who would be willing to serve as references.

I certify that all the information that I provide on this volunteer application and in any interview will be complete, true and accurate. I understand that if any such information is later found to be incomplete, false or misleading in any way it may be considered sufficient cause for termination of my volunteer service. I agree that Catholic Medical Center and any of the references provided on this application, may exchange information regarding my qualifications without incurring any liability whatsoever for supplying such information. I understand that I will not be paid for my services as a volunteer. I agree to abide by all organization and volunteer policies. I understand that CMC is not obligated to provide volunteer placement, nor am I obligated to accept the volunteer assignment offered.

Please note: Volunteer placement is subject to:

  • Satisfactory reference reports and criminal record check.
  • Satisfactory medical history review and required testing.
  • Personal interview with the Manager of Volunteer Services, and/or department staff as required
  • Ability to make the required minimum time commitment.
  • Willingness to abide by all hospital requirements and regulations.

My typed name below shall have the same force and effect as my written signature.


Qualified applicants shall receive consideration regardless of race, religion, color, creed, national origin, sexual orientation, age, disability, marital status or any other legally protected status.