Thank you for your interest in volunteering at River Falls Area Hospital! Please complete this application form, and click the submit button at the bottom. Once you have submitted your application form, we will contact you to schedule a volunteer placement interview.

• To complete this application, you will need to include a name and address of a personal reference who is not a relative.

• A valid email address is required to use the on-line Application process. Please make sure you type the email correctly - as it will be used as a communication tool in the application process.

• All items with an asterisk (*) are required

Name and Address

First name:

Last name:

Middle name:

Nickname:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Home phone:

* OK to call me here

Cell phone:

OK to call me here

Email address:

Date of birth:

(year optional)

Availability

Volunteer shifts are typically one time per week, scheduled according to the department need and volunteer availability. volunteers are asked to make a minimum commitment of one shift per week for 6 months or 60 hours. Please indicate the days and times you are usually available to volunteer.

Education

Please list highest level of education completed.

Education:

School:

Work Experience

Please identify any relevant work experience (volunteer or paid)

Employer name:

City:

State:

Zip:

Work phone:

List any work / volunteer experience that relates to a volunteer opportunity.

Immunization Information

Evidence of immunity is a requirement for volunteering at RFAH. Should an opportunity be available, further information will be provided on how to begin the health clearance process.

Personal Reference Information

Please provide a personal reference who is not a relative.

First name:

Last name:

Title:

Home phone:

Work phone:

Cell phone:

Relationship:

Emergency Contact Information

First name:

Last name:

Home phone:

Work phone:

Cell phone:

Email Preferences

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.

What kinds of email would you like to receive?

Electronic newsletters

Recruitment appeals

How did you learn about the volunteer program?

Volunteer Applicant Consent

Thank you for taking the time to complete this application. By checking this box you are indicating that the information in this application is accurate and correct to the best of your knowledge.

You are also indicating your approval for us to verify references and perform a State background study.

Failure to fully and truthfully complete this application may result in denial of volunteer service or termination from the service. River Falls Area Hospital is not obligated to provide placement, nor are you obligated to accept the position offered. We reserve the right to place volunteers in the area we feel is best suited to their skills and the needs of the hospital. River Falls Area Hospital is committed to providing Equal Employment Opportunities to all employees and applicants.

EEO/AA

I Agree