Volunteer Application Form
Please complete this application form if you are interested in becoming a Marion General Hospital volunteer. Once you complete the form, click the submit button at the bottom. You will be contacted within 10 business days.
Name and address
First name:
*
Last name:
*
Street 1:
*
Street 2:
Street 3:
City:
*
State:
Choose
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
*
Zip:
*
Home phone:
*
OK to call me here
Work phone:
OK to call me here
Email address:
Social security #:
1
2
1
2
First name:
*
First name:
*
Last name:
*
Last name:
*
City:
*
City:
*
State:
Choose
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
*
State:
Choose
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
*
Zip:
*
Zip:
*
Home phone:
*
Home phone:
*
1
2
First name:
*
First name:
*
Last name:
*
Last name:
*
Street 1:
*
Street 1:
*
City:
*
City:
*
State:
Choose
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
*
State:
Choose
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
*
Zip:
*
Zip:
*
Home phone:
*
Home phone:
*
Cell phone:
Cell phone:
Relationship:
Choose
Brother
Co-worker
Daughter
Doctor
Father
Friend
Grandfather
Grandmother
Husband
Mother
Mother-in-law
Neice
Neighbor
Parents
Pastor
relative
Sister
Sister-in-law
Son
Spouse
Supervisor
Wife
*
Relationship:
Choose
Brother
Co-worker
Daughter
Doctor
Father
Friend
Grandfather
Grandmother
Husband
Mother
Mother-in-law
Neice
Neighbor
Parents
Pastor
relative
Sister
Sister-in-law
Son
Spouse
Supervisor
Wife
*
Demographic Information
You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.
Date of birth:
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
26
27
28
29
30
31
Year
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
*
Gender:
Choose
Female
Male
*
Education:
Choose
Associate degree
College degree
Doctoral degree
Eastbrook High School
High school
IWU
Marion High School
Masters degree
Some college
Trade/Vocational school
*
Availability
Please indicate the days and times you are usually available to volunteer.
Sun
Mon
Tue
Wed
Thu
Fri
Sat
Morning:
Afternoon:
Evening:
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
Employer Name
Please enter the names, addresses and phone numbers of your last two employers.
References
Please list two character references who are not related to you.
Authorization to Make Contact
Please answer all questions. Failure to follow these insructions will be grounds to deny volunteer assignment. Submission of resumes will not be accepted in lieu of a fully completed and signed Volunteer Applicaton. I authorize Marion General Hospital to contact all former and/or present employers, references and any other agency, business and/or individual that Marion General Hospital deems necessary to contact during its investigation of my background. I also agree to indemnify and hold harmless Marion General Hospital for any and all disclosures made to or by it in good faith relating to my volunteer service. We consider applications for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, disability, affiliation with a labor organization or any other legally protected status. I certify that all information submitted by me on this application is true and complete, and I understand that any false statements omissions shall be sufficient cause for denial of a volunteer position or dismissal, regardless of time of discovery by the Hospital. I understand that an offer of a volunteer position is contingent upon completion of a job related post-offer TB test. I understand that if accepted as a volunteer, I will be on a provisional status for a minimum of 90 days. I also understand that if selected, my volunteer service is for no definite period and may be terminated at any time with or without prior notice. I understand that I will not be considered an employee of Marion General Hospital and that, if accepted as a volunteer, I agree to donate my time with no expectation of pay.
I Agree
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