Adult Volunteer Application

Thank you for choosing WellSpan Health to volunteer!

Please complete the entire application. Once completed, click the submit button at the bottom.

PLEASE NOTE: Submitting an application does not guarantee acceptance into the Wellspan Health Volunteer Program. Your application will be reviewed and if initial qualifications are met, you will be contacted (via email or phone) to schedule an Orientation session. Once you have attended Orientation, an interview will be conducted to determine placement as well as a Health Screening and additional training (if needed).

Applicant Information:

Please provide your legal name (i.e. no nicknames).

Emergency Contact:

In the event of an emergency whom should we notify?

First name:

Last name:

Home phone:

OK to call here

Work phone:

OK to call here

Cell phone:

* OK to call here

Relationship:

Employment Status

What Inspires You to Volunteer with WellSpan?

What inspires or motivates you to volunteer with WellSpan?

Volunteer Experience:

Have you volunteered in the past? If yes, please list the name of the agency, date and volunteer role.

What Is Your Availability for Volunteering?

Sun

Mon

Tue

Wed

Thu

Fri

Sat

From:

To:

Volunteer Commitment:

Due to the on-boarding and training requirements, WellSpan asks new Volunteers to commit to a minimum of 100 hours of service, completed within a twelve-month period.

* Are you willing to make this commitment:

Yes

If no, please explain:

What Type of Volunteer Assignment Interests You?

Which Location Would You Like to Volunteer?

Community Service:

Please provide us with information if you are looking to volunteer as part of a community service requirement.

* Community Service Requirement?:

Yes

List name of organization/agency, number of hours and deadline for completion.

Miscellaneous:

WellSpan requires all Volunteers to obtain specific clearances. Please answer the following question related to felony or misdemeanor convictions.

NOTE: A conviction record does not necessarily prevent you from volunteering for Wellspan.

* Misdemeanor or Felony Conviction?:

Yes

If you marked yes, please provide the date, state and town the conviction occurred.

References:

Please provide us with names and email addresses of two (2) personal references who can comment on your ability to serve as a volunteer. All references will be contacted.

References cannot be relatives and must have known you for at least one(1) year.

1

2

First name:

Last name:

Email address:

Relationship:

I Agree

I hereby certify that all statements and answers set forth on the application are true and complete to the best of my knowledge. I understand that if any statements and/or answers are found false or information has been omitted, such false statements or omissions may be cause for rejection or termination of my volunteer application or service. I understand that in processing my application with WellSpan Health Volunteer Engagement, an investigative report will be conducted to obtain and verify information relating to my past activities and background. Information may include, but is not limited to: criminal records, child abuse clearances and any data provided on this application or during the interview process. I permit the Volunteer Engagement department to use my name, photograph or video as a volunteer for publicity purposes when necessary.

By submitting this form, I attest that the information I have provided on the form is true and accurate.

I Agree