Please complete this application form if you are interested in becoming a South Seminole Hospital volunteer. Once completed click the Continue button, which is located at the end of the form. This will submit your application. If you have provided an e-mail address, an automated confirmation will be sent to you.

Basic Information

Please provide current information. Make sure to include your E-mail address and a home phone and/or cell phone number.

First name:

Last name:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Home phone:

Work phone:

Cell phone:

Email address:

Date of birth:

Gender:

Marital Status:

Social security number:

What kinds of email would you like to receive?

Newsletters/Vic Mail
Important reminders and updates that involves your volunteer schedule or activities.

My availability is:

From:

to:

Education, Employment and/or Volunteer Experience

Please include the above information, in addition to specific medical training and/or experience.

Education:

School:

Interests and Abilities

Emergency Information

First name:

Last name:

Street 1:

City:

State:

Zip:

Other phone:

Relationship:

References

Please provide three adult, non-relative references.

FOR ADULTS - one of the three references must be business or professional.

FOR HIGH SCHOOL STUDENTS - one of the three references must be a teacher or counselor.

1

2

First name:

Last name:

Street 1:

City:

State:

Zip:

Home phone:

Email address:

Relationship:

3

First name:

Last name:

Street 1:

City:

State:

Zip:

Home phone:

Email address:

Relationship:

FOR APPLICANTS UNDER 18 ONLY

Please provide the name of your parent or guardian, who consents to, and supports, your decision to volunteer.

Agreement Section

I understand and agree that, as a condition of being selected as a volunteer at Orlando Health South Seminole Hospital, Orlando Health will conduct a criminal background check. My signature below constitutes my authorization for Orlando Health or its agents to check my background. I waive and release Orlando Health and its agents from any and all claims I may otherwise have with respect to any such criminal background check.

I Agree