Please complete this application form if you are interested in becoming a California Pacific Medical Center Volunteer Services volunteer. Once you complete the form, click the submit button at the bottom. Privacy Policy information regarding our website can be viewed by clicking the words Privacy Policy located at the bottom left corner of the application.

Name and address


Emergency Contacts


Demographic Information (OPTIONAL)

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.


Experience/Knowledge/Skills

In which of these areas do you feel you have moderate to excellent knowledge, experience and/or skills? Check all that apply.


Languages

Which of these languages do you consider yourself to be conversationally fluent?


Interests

Please check any personal or health interests.


Schedule of Availability

Please indicate the days and times you are usually available to volunteer.


Volunteer Assignment Area Preference

Please check the general category that best fits your area of interest for volunteering.


Site/Campus Preference

Please check the CPMC Campus where you would prefer to volunteer.


Employment


Why are you interested in volunteering?


Additional Information


Agreement/Acceptance of Terms

I agree and understand that as a volunteer, I do not expect payment for any services I provide for the volunteer program. I agree to serve a minimum of 100 hours. I understand and agree that submitting this application form does not automatically register me as a volunteer, and that there are certain qualifications I must meet, including the acceptance of established volunteer policies and procedures, before I begin volunteering. I understand that any deliberate, incomplete, incorrect or false statements may result in dismissal.