Elmhurst Hospital Volunteer Application

Due to the Coronavirus Pandemic, we are not able to accept volunteers. Please check back with us after May 1 for an update.

Thank you.

Profile

Date of birth:

Gender:

Education:

Marital Status:

Referred By:

Second Language:

Current School Attending:

Military Service-Branch:

Year Graduating:

Military Service:

Interested in Medical Career:

Military Service:

Personal Information

Please fill out all sections

First name:

Last name:

Middle name:

Type:

Street 1:

City:

State:

* Zip: *

Home phone:

* OK to call me here

Work phone:

OK to call me here

Cell phone:

* OK to call me here

Email address:

Email Preferences

Emergency Contacts

First name:

Last name:

Street 1:

City:

State:

Zip:

Home phone:

Work phone:

Cell phone:

Relationship:

Volunteering at Elmhurst Hospital

Briefly describe your reason for choosing Elmhurst Hospital. TEENS, please include any sports, clubs, activities and achievements in this section

What kinds of email would you like to receive?

Teen Volunteer Correspondence
Communication between high school students and Volunteer Supervisor is extremely important. It is highly advisable to review all emails received by the Volunteer Services Staff. Please check your spam email if you feel you have not been notified in a timely manner. (one-two weeks)

Recruitment appeals

News Update

From The Desk Of...

Checklist reminders

Volunteer or Customer Service Experience

Please provide previous volunteer and customer service experience.

Availability

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

Sun

Mon

Tue

Wed

Thu

Fri

Sat

From:

To:

My availability is:

From:

to:

Service Hours Availability:

hours:

Skills and Interest

Physical activities & hobbies

Some volunteer positions require standing and walking for long periods of time, please describe your level of activity?

Volunteer Hour Requirement

Are you required by court order or school requirment to serve volunteer hours? How many hours?

Criminal History

Have you ever entered a plea other than "not guilty", pleaded "nolo contendere", or been convicted of a crime either felony or misdemeanor?

If you answered yes, please explain. Court referrals will only be considered if referred by Dupage County Department of Probation and Court Services.

Reference

One reference is required

First name:

Last name:

Street 1:

City:

State:

Zip:

Home phone:

OK to call here

Work phone:

OK to call here

Cell phone:

Email address:

Relationship:

One reference is required

Agreement Statement

I certify that the statements made in this volunteer application are true and correct. I understand that this information may be disclosed to any party with legal and proper interest and I release Elmhurst Memorial Hospital to contact any of my schools, former employers or other references to provide applicable information relevant to the volunteer position for which I am applying. Representatives of Elmhurst Memorial Hospital, in separate documentation, will ask to obtain a criminal background report. I understand that this consent is valid for the duration of my volunteer assignment. I release Elmhurst Memoiral Hospital as well as any schools, employers, law enforcement authorities or other references from any liability as a result of the verification process. I understand that if I falsified any information or omitted any material facts, termination of volunteer assignment may result at any time. I agree to abide by requirements set by the Volunteer Services Department, which includes annual medical screening and annual safety training.

I Agree