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:

* 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:

Last name:

City:

State:

Zip:

Home phone:

1

2

First name:

Last name:

Street 1:

City:

State:

Zip:

Home phone:

Cell phone:

Relationship:

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:

Gender:

Education:

Availability

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

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