Please complete this application form if you are interested in becoming a Mon Health System Volunteer. When the form is complete, click the submit button at the bottom.


APPLICANT


EMERGENCY CONTACT


AVAILABILITY

**If you are applying for the Explorer Program, you do not need to add availability**



OTHER


OTHER


OTHER


REFERENCES (you may not use relatives)


MON HEALTH SYSTEM AGREEMENT

Believing that Mon Health System has need of my services as a Volunteer worker, I agree to: Hold as absolutely confidential ALL information which I may obtain directly or indirectly concerning patients, doctors or personnel and I will not seek out confidential information in regard to a patient. My services are donated to Mon Health System without contemplation of compensation or future employment and given with humanitarian or charitable reasons.


Opportunities for Volunteers are provided without regard to religion, creed, race, national origin, age, sex or disability.


NOTE: Filling out an application does not assure placement, since the number of applicants usually exceeds the number of available openings. Applicants will be chosen on the basis of qualifications in keeping with the best interest of the Mon Health System.


The first month of volunteer experience will be mutually probationary. All applications will be kept on file for (90) days.




I Agree