Volunteer Application (New)

Volunteer Application
I'm applying to be a *
Personal Information
Applicant's Name *

First NameMiddle NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date*

MonthDayYear
Date
Phone Number*

Area CodePhone Number
Email*
example@example.com

Junior volunteers do not need to complete the work related availability section. Please continue this application by clicking next below.
YesNo
If yes, list addresses of residence:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date range of residency:
Example: May 2016-September 2017
NoOther

Rows	Monday
Mornings (any time before noon)
Afternoons (between noon and 4pm)
Evenings (4pm-7pm)
Not available

Rows	Tuesday
Mornings (any time before noon)
Afternoons (between noon and 4pm)
Evenings (4pm-7pm)
Not available

Rows	Wednesday
Mornings (any time before noon)
Afternoons (between noon and 4pm)
Evenings (4pm-7pm)
Not available

Rows	Thursday
Mornings (any time before noon)
Afternoons (between noon and 4pm)
Evenings (4pm-7pm)
Not available

Rows	Friday
Mornings (any time before noon)
Afternoons (between noon and 4pm)
Evenings (4pm-7pm)
Not available

Rows	Saturday
Mornings (any time before noon)
Afternoons (between noon and 4pm)
Evenings (4pm-7pm)
Not available

Rows	Sunday
Mornings (any time before noon)
Afternoons (between noon and 4 pm)
Evenings (4pm-7pm)
Not available

Education
High schoolCollegePost graduateDegrees
School attending *
Counselor name

Emergency Contact Information

In an emergency, please notify:
Emergency contact: Name*

First NameLast Name
Relationship:*
Emergency contact: Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency contact: Phone number *

Area CodePhone Number
Physician name
Physician phone number

Area CodePhone Number

Junior volunteers do not need to complete the personal references section. Please continue this application by clicking next below.
Personal references:

Please list two references. Do not use your physician(s) or relatives.
Reference #1
Reference #1: Name *

First NameLast Name
Relationship *
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email
example@example.com
Reference #2
Reference #2: Name

First NameLast Name
Relationship
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Most current work reference
Current work reference: Company name *
Your title:*
Name of supervisor:*
Phone number:*

Area CodePhone Number
Supervisor's email:
example@example.com
Start date *

MonthDayYear
Date
End date*

MonthDayYear
Date
Current work reference: Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Describe your duties:*
NoYes

Confirmation
I certify that all information I have provided in order to apply for and secure work with Reid Health is true, complete and correct. I understand that any offer of volunteering I receive will be contingent on a background check and review of my references. I authorize, without reservation, the Hospital, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employees, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application or volunteer interview. I waive any and all rights and claims I may have against the Hospital, its agents, employees or representatives, for seeking, gathering and using information in the volunteer process and all other persons, corporations or organizations for furnishing such information about me. I understand that this application remains current for one year. At the conclusion of that time, if I have not heard from the Hospital and still wish to be considered for volunteering, it will be necessary for me to reapply and fill out a new application. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will result in (i) my elimination from further consideration for volunteering; or (ii) the immediate termination of my volunteer position with the Hospital, regardless of the date of discovery. I certify that I have read, fully understand and accept and agree to all terms of the foregoing Applicant Certification.
Date signed: *

MonthDayYear
Date
Signature*

At Reid, our basic mission is to serve the needs of our customers. However, we must make every effort to exceed their expectations and win their loyalty.

The quality that we seek in our volunteers is a positive approach toward job duties and all interactions with Reid customers and with other employees and volunteers.

The selection process is complex, because we consider every decision important to Reid’s mission. Therefore, the overall goal of the process is to identify those most likely to enhance customer service and help us exceed expectations.

Please take a few minutes to answer the questions below and submit with your application. Your application will not be considered without this section. Please feel free to use additional paper if needed.
1. You are walking down a hall at Reid Health. You notice a woman who appears upset and frustrated. Describe your reaction:*
2. Think of a place you like a lot because of the great service they give to customers. List the things that you like about that place:*
3. Many people are stressed and anxious when they come to a hospital. How could you – as a volunteer – ease the situation for a patient or a patient’s family member? *
4. Share how you will commit to Reid’s C.A.R.E. Standards of showing Courtesy to those around you, an Attitude that is positive, Respect for individuals regardless of differences and Enthusiasm for what you do and how you care? *
Should be Empty:

Volunteer Application

Personal Information

Education

Work

Emergency Contact Information

Background information

Personal references:

Most current work reference

Confirmation