Volunteer Application Form
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:
Choose
WI
*
Zip:
*
Home phone:
*
OK to call me here
Cell phone:
OK to call me here
Email address:
*
Date of birth:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
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Sep
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Dec
Day
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Year
2023
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1925
1924
1923
1922
1921
1920
1919
1918
(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.
Sun
Mon
Tue
Wed
Thu
Fri
Sat
Morning:
Afternoon:
Evening:
My availability is:
Choose
Alternating 1st & 3rd
Alternating 2nd & 4th
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
3
4
5
6
7
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29
30
31
Year
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
to:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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27
28
29
30
31
Year
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
Assignment Preference:
Clerical/Administrative [Volunteer Services]
Front Desk Greeter [Volunteer Services]
Gift Kiosk Cashier [Volunteer Services]
Greeter - Marketing Events [Volunteer Services]
Materials Inventory Aide [Materials / Purchasing Department - RFAH]
Patient-Family Befriender [Volunteer Services]
Plants - Gardening [Volunteer Services]
Volunteer Advisory Council [Volunteer Services]
VPCC Helping Hand [Virginia Piper Cancer Institute - River Falls]
List areas you wish to volunteer that are not listed above or any special skills that may assist us in placing you.
Education
Please list highest level of education completed.
Education:
Choose
Associate degree
College degree
Doctoral degree
High school
Masters degree
Some college
Trade/Vocational school
School:
Work Experience
Please identify any relevant work experience (volunteer or paid)
Employer name:
City:
State:
Choose
WI
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:
Choose
Dr.
Mr.
Mrs.
Ms.
Home phone:
Work phone:
Cell phone:
Relationship:
Choose
Co-worker
Daughter
Father
Friend
Mother
Neighbor
Son
Spouse
Supervisor
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
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