Volunteer Application Form
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:
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Street 2:
Street 3:
City:
*
State:
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AK
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MI
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MS
MT
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NH
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OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
*
Zip:
*
Home phone:
*
Work phone:
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Cell phone:
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Email address:
*
Date of birth:
Month
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1917
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Gender:
Choose
F
M
*
Marital Status:
Choose
Divorced
Married
Single
Widow/Widower
*
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:
Choose
Ongoing
Ongoing, except between these dates
Only between these dates
*
From:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
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Year
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
*
to:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
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5
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31
Year
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
*
Education, Employment and/or Volunteer Experience
Please include the above information, in addition to specific medical training and/or experience.
Education:
Choose
College Graduate
College Student
High School Graduate
High School Student
Other
*
School:
Interests and Abilities
Emergency Information
First name:
*
Last name:
*
Street 1:
*
City:
*
State:
Choose
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
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
*
Zip:
*
Other phone:
*
Relationship:
Choose
Aunt
Boyfriend/Fiancee
Brother
Brother-In-Law
Cousin
Co-worker
Daughter
Daughter-In-Law
Domestic Partner
Ex-Spouse
Father
Father-In-Law
Friend
Girlfriend/Fiancee
Granddaughter
Grandfather
Grandmother
Grandson
Guardian
Guidance Counselor
Mother
Mother-In-Law
Neighbor
Nephew
Niece
Sister
Sister-In-Law
Son
Son-In-Law
Spouse
Step-Father
Step-Mother
Supervisor
Teacher
Uncle
*
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:
*
First name:
*
Last name:
*
Last name:
*
Street 1:
*
Street 1:
*
City:
*
City:
*
State:
Choose
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
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
*
State:
Choose
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
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
*
Zip:
*
Zip:
*
Home phone:
*
Home phone:
*
Email address:
*
Email address:
*
Relationship:
Choose
Aunt
Boyfriend/Fiancee
Brother
Brother-In-Law
Cousin
Co-worker
Daughter
Daughter-In-Law
Domestic Partner
Ex-Spouse
Father
Father-In-Law
Friend
Girlfriend/Fiancee
Granddaughter
Grandfather
Grandmother
Grandson
Guardian
Guidance Counselor
Mother
Mother-In-Law
Neighbor
Nephew
Niece
Sister
Sister-In-Law
Son
Son-In-Law
Spouse
Step-Father
Step-Mother
Supervisor
Teacher
Uncle
*
Relationship:
Choose
Aunt
Boyfriend/Fiancee
Brother
Brother-In-Law
Cousin
Co-worker
Daughter
Daughter-In-Law
Domestic Partner
Ex-Spouse
Father
Father-In-Law
Friend
Girlfriend/Fiancee
Granddaughter
Grandfather
Grandmother
Grandson
Guardian
Guidance Counselor
Mother
Mother-In-Law
Neighbor
Nephew
Niece
Sister
Sister-In-Law
Son
Son-In-Law
Spouse
Step-Father
Step-Mother
Supervisor
Teacher
Uncle
*
3
First name:
*
Last name:
*
Street 1:
*
City:
*
State:
Choose
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
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
*
Zip:
*
Home phone:
*
Email address:
*
Relationship:
Choose
Aunt
Boyfriend/Fiancee
Brother
Brother-In-Law
Cousin
Co-worker
Daughter
Daughter-In-Law
Domestic Partner
Ex-Spouse
Father
Father-In-Law
Friend
Girlfriend/Fiancee
Granddaughter
Grandfather
Grandmother
Grandson
Guardian
Guidance Counselor
Mother
Mother-In-Law
Neighbor
Nephew
Niece
Sister
Sister-In-Law
Son
Son-In-Law
Spouse
Step-Father
Step-Mother
Supervisor
Teacher
Uncle
*
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
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