This application is for the West O`ahu location only.


Please complete this application form if you are over 18 years of age, able to commit to at least 64 hours of volunteer service and are enthusiastic about volunteering at The Queen's Mecial Center - West O`ahu.


Please be sure to complete each section of the application. Once complete, click the "Continue" button.


Note: This form may not automatically reformat for your mobile device.


NAME AND ADDRESS


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.



THE QUEEN'S MEDICAL CENTER

If you are currently employed, have been employed or have volunteered at The Queen's Medical Center, The Queen's Medical Center West O`ahu, North Hawaii Community Hospital or one of The Queen's Health Systems companies, please provide details in the box below.




VOLUNTEER EXPERIENCE

If you currently volunteer or have volunteered at other organizations, please detail when, where and your position or tasks in the box below.



CURRENT EMPLOYMENT


STUDENT

If you currently attend high school, college or university please use the drop down menu to select your school. If it does not appear, please note the name of your school in the box below.



AVAILABILITY

Before selecting, please view the Volunteer Opportunity Directory. Copy and paste the following link into your browser: www.volgistics.com/ex/portal.dll/OD?FROM=12167.


Your schedule will be based on the information you provide.



SKILLS AND INTERESTS


REFERENCES

Please list two (2) reference whom we may contact. Exclude family members.



EMERGENCY CONTACT

Whom should be contacted if you become ill or injured while volunteering?



VOLUNTEER APPLICANT CONVICTION RECORD INQUIRY *

THIS SECTION MUST BE COMPLETED BY ALL APPLICANTS.


An offer to be a volunteer is conditioned upon the following inquiry into your conviction record. For purposes of this inquiry, a conviction means an adjudication by a court of competent jurisdiction that an individual has committed a crime. Conviction includes a judicial, military or other similar law enforcement judgment, verdict, or adjudicatory finding that an individual has committed a criminal offense; provided that the judgment verdict acceptance or finding has not been reversed, annulled, expunged or vacated. This inquiry does not include any questions about crimes committed as a juvenile which are required to be kept confidential pursuant to Section 571-84, Hawaii Revised Statutes.


Please enter your responses in the box below, accurately and completely to the questions set forth below:

1. Full Legal Name.

2. Have you ever been convicted of a criminal offense in the past 10 years? Yes or No.

If you answered No to question 2, please continue to the Email Preferences section.

If you answered Yes to question 2, please provide the following information in the space provided as to each conviction.

3a. The nature of the criminal offense.

3b. The date of conviction.

3c. Location (city, state) of conviction.

3d. Why the company should consider your application in light of your conviction record.



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.



Pledge

I am over the age of 18 years and understand that I will not receive remuneration for the volunteer service I provide.


I will commit to at least 64 hours of volunteer service.


I certify that the information I have provided in response to the questions on this application is true and correct. I understand that any false or misleading statements or omissions, whenever they are discovered, are grounds for disqualification from further consideration or for dismissal from volunteering.


I understand and agree that the Company may require a response to the conviction inquiry before I commence volunteering. I also understand and agree that if I refuse to comply with the conviction inquiry, the Company may refuse to accept me as a volunteer on the basis of my refusal to comply. I also understand and agree that the Company will withdraw its conditional offer for me to volunteer if I have a conviction record that bears a rational relationship to the duties and responsibilities of a volunteer.