Complete this application if you are at least 18 years old & interested in becoming a volunteer at Upstate University Hospital. Once you complete the application, click the "continue" button at the bottom.


Please Note - This application is for adults 18 years of age, or older and those who are NOT currently a traditional FT student. TEEN & COLLEGE STUDENT APPLICATIONS ARE ACCEPTED UNDER SEPARATE COVER AT CERTAIN TIMES OF THE YEAR.


Demographic Information

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



Emergency Contact


Campus Preference

Please choose the location you would prefer to volunteer at (this can absolutely change after you hear more about our program):

Downtown: 750 E. Adams St, Syracuse, NY 13210

Community: 4900 Broad Rd, Syracuse, NY 13215 (near OCC)



Affiliations with Upstate

1. Do you have any current or prior affiliations with Upstate Medical University or Upstate University Hospital? If so, please check the box below and list any former positions and departments. If possible, include your prior Upstate ID number.


2. Do you have a relative currently employed by Upstate?


3. Are you now, or have you in the past, applied for employment with Upstate?



Volunteering at Upstate

We are interested in learning about what led you to us:


1) How did you hear about our volunteer program?


2) Why do you want to volunteer at Upstate University Hospital?


3) What areas within the hospital interest you the most (what would you like to do as a volunteer at Upstate)?



Availability

A commitment of one 4-hour shift per week, on a regular schedule is required (ex: 12pm-4pm Thursdays). Positions are typically weekdays, during business hours.


Please list any schedule preferences you have and any future travel plans that would make you unavailable to volunteer for an extended period of time.



Recent Volunteer Experience

Please list any recent volunteering experience you have.



Criminal Background Information

Have you ever been convicted of a misdemeanor or felony that was not dismissed, expunged, or sealed? If yes, please provide date, charge, court, and disposition.


Please be advised that Upstate Medical University & Upstate University Hospital conducts background checks on all new hires and volunteers. Prior criminal conviction(s) may not prevent you from getting the volunteer position. However, falsifying your volunteer application is grounds for withdrawal of a position offer or termination.



Performance & Risk

1. Do you have any condition or disability that might interfere with the performance of your duties as a volunteer?

2. Do you have any condition or disability that may be a potential risk to patients or personnel at Upstate University Hospital?


If you answered yes to either of the above, please provide further remarks below.



Automobile Information

If you will be driving, please provide the following information for the vehicle you will park in the Upstate Garage, free of charge.


A) Year, Color, Make & Model

B) License Plate # (*Please indicate if not a NY Plate)



Requirements

Please note, if you are UNABLE to check all boxes below, you are NOT eligible to apply at this time; DO NOT submit an application.



References

Please give contact information for 2 references* we may speak with regarding your interest in volunteering at Upstate University Hospital. *Not relatives



Volunteer Service Agreement

I submit my name and information for consideration to volunteer at Upstate University Hospital and certify that the information contained in this application is true and correct to the best of my knowledge.


I understand that submission of this application does not guarantee my participation in the Upstate Volunteer Program and being granted an interview does not guarantee selection.


I understand that, ideally my association as a volunteer will extend far into the future, but a commitment of at least 50 hours is expected during the first 6 months of service. In addition, I agree that I will follow all of the rules set out in the Office of Volunteer Programs Handbook, the Upstate Pledge and always maintain strict confidentiality of all patient information.