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Careers & Volunteering
Volunteer Opportunities Form
Personal Information
First Name:
Middle Name:
Last Name:
Address1:
Address2:
City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
-
Home Telephone Number:
(
)
-
Work Telephone Number:
(
)
-
x
Overview
How did you become interested in volunteering at St. Joseph Healthcare?
(Check all that apply)
Poster/Newspaper
ASPIRE
Referred by current volunteer
NOE
RSVP
Walk-in
Other
What service areas are you interested in working as a volunteer?
(Check all that apply)
Escorting Patients
Dietary
Front Desk or Reception
Offices or Medical Records
Patient Services
Gift Shop
Other
Please check the following skills you could provide to the Volunteer Services Department:
General Office
Filing
Typing
Mailings
Photocopying
Retail Sales
Housekeeping/Laundry
Customer Service
Public Speaking
Computer (please specify)
Other
How many hours are you interested in providing to St. Joseph Healthcare each week?
What days and hours during the week would you be able to volunteer?
Have you worked or volunteered at St. Joseph Healthcare in the past?
Yes
No
If yes, in what capacity?
Employee
Adult Volunteer
Junior Vonunteer
Other:
Position(s) held:
Years:
Have you been convicted of a crime (please include moving violations)?
Yes
No
If yes, please explain:
Education
High School/GED
School/Institution
Number of years completed:
Graduation:
Yes
No
College/Technical School
School/Institution:
Number of years completed:
Course of Study:
Degree Awarded:
References
Please list three people you have known for at least two years who could attest to your good character and/or work history.
Please do not include relatives or minors (under 18)
. Please provide complete and accurate mailing addresses and telephone numbers for all references.
Reference 1
Name:
Address:
City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
-
Home Telephone Number:
(
)
-
Reference:
Character Reference
Work Reference
Reference 2
Name:
Address:
City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
-
Home Telephone Number:
(
)
-
Reference:
Character Reference
Work Reference
Reference 3
Name:
Address:
City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
-
Home Telephone Number:
(
)
-
Reference:
Character Reference
Work Reference
Please read our
volunteering terms
carefully before submitting.
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