If you are a college student, please complete the College Student Application. A minimum volunteer commitment of six (6) months is requested. Please consider your ability to make such a commitment before applying.



CONTACT INFORMATION


EMERGENCY CONTACT

In the event of an emergency whom should we notify?



PERSONAL REFERENCES

Do NOT list relatives; Must be at least 21 years of age



EMPLOYMENT STATUS

Please describe your current work status.



PREVIOUS VOLUNTEER EXPERIENCE


SPECIAL SKILLS


DAYS/HOURS AVAILABLE


SPECIFIC AREAS OF INTEREST

You may read about current openings by visiting www.anmedhealth.org/volunteer and clicking on Volunteer Opportunities.



HOW DID YOU HEAR ABOUT OUR PROGRAM?

(If you heard about our program from an AnMed Health volunteer or employee, please list that person's name.)



CRIMINAL BACKGROUND STATEMENT

Have you ever been convicted, pled guilty, pled no contest, or forfeited bond to a violation of any federal, state, county or municipal law, regulation or ordinance other than minor traffic offenses (including bad check/fraudulent check & convictions as a result of court martial)?



APPLICANT AGREEMENT

The information provided on this application is true in all respects, without any willful omissions. I understand that if this application is false in any way I may be dismissed without notice. By signing this application I give permission for the AnMed Health Volunteer Services department to contact the above named individuals in order to obtain personal reference information. As a participant in the volunteer program at AnMed Health, I:

- Agree to satisfy all orientation requirements

- Agree to comply with all policies and procedures of AnMed Health and the Volunteer Services Department

- Understand that I may be dismissed from my duties for any unauthorized viewing, discussion or disclosure of patient information

- Understand that volunteers are subject to "for cause" drug screenings

- Understand that I am not entitled to any form of compensation or benefits