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Volunteer Application

Date: 4/24/2014

Personal Information

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Mr. Mrs. Ms. Dr. Other
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Male Female

Address Information

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Contact Information

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Cell Home Other
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Education

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Employment Information

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Employed Full Time Employed Part Time Unemployed Retired Student
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Work Schedule Information

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General Information

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CMC Newsletter CMC Website I am a current/former employee of CMC
I attended a CMC event I called CMC I was a patient at CMC
Newspaper Radio Television
Volunteer Department Brochure I was referred by someone  
If referred by someone, please enter:
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Volunteer Employee Friend Family Member
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I would like to volunteer at the hospital
I would like to volunteer at one of CMC's off campus Community Programs
I would consider a volunteer assignment at either the hospital or a community program

Committment

Regarding the length of your commitment to volunteer service:

Yes No

Yes No
If you checked yes, please answer the following question also:

Continue Volunteering Resign at that time
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.

Availabiliy

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

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References

Please list two people other than relatives, who have known you for more than one year, who would be willing to serve as personal references.

Reference 1
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Reference 2
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Please print, sign and mail this reference form to each of your two personal 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:

  1. Satisfactory reference reports and criminal record check.
  2. Satisfactory medical history review and required testing
  3. Personal interview with the Director of Volunteer Resources, and/or department staff as required
  4. Ability to make the required minimum time commitment.
  5. Willingness to abide by all hospital requirements and regulations.

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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.

Phone
  • (800) 437-9666
  • (603) 626-2626
  • (603) 663-6498
  • (603) 663-5270
  • (603) 663-6431
  • (603) 663-8031
  • (603) 663-6667
  • (603) 669-0413
  • (603) 663-6395
  • (603) 663-7377
  • (603) 314-4567
  • (603) 663-8000
Directions
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Approximate Distance
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Our Mission
"The heart of Catholic Medical Center is to provide health, healing and hope in a manner that offers innovative high quality services, compassion, and respect for the human dignity of every individual who seeks or needs our care as part of Christ's healing ministry through the Catholic Church."