Volunteer Application Form

Please complete this application form if you are interested in becoming a Valley Medical Center volunteer. Valley Medical Center has a minimum volunteer requirement of 4 hours per week for a minimum of six months. Once you complete the form, click the submit button at the bottom.

We will notify you via email or by phone when a position becomes available. Please watch your email for notices.

Contact Information

First name:

Last name:

Middle name:

Nickname:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Home phone:

* OK to call me here

Cell phone:

OK to call me here

Demographics

Date of birth:

Gender:

Education:

Language

Please check all languages spoken.

Availability

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

Skills & Experience

Please indicate any skills or experience that you have that may be useful for us to place you into a volunteer assignment.

Skills & Interests:

Please share any skills and prior experience that you have.

Assignment Options

Valley Medical Center has many different areas of the hospital that have volunteer opportunities. Most positions are hospitality in nature and include clerical duties. Direct patient care opportunities are not available.

Cancer Resource Center volunteers support patients by linking them to American Cancer Society programs that provide: rides to treatment, peer support, makeup courses and free makeup (for women), assistance finding free or reduced-rate lodging and more. These volunteers also help empower patients and their loved ones by linking them to other community resources.

Current openings include:

- Gift shop ***

- Medical Arts Center Info Desk

- Shuttle Driver **

-Pet Therapy(TDI trained)

Emergency Contact

In the event of an emergency whom should we notify?

First name:

Last name:

Title:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

Home phone:

Cell phone:

Email address:

Relationship:

Employer

Please list your current or most recent employer, if applicable.

1

2

Employer/School Name:

First name:

Last name:

Title:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

Home phone:

Work phone:

Relationship:

References

Employer/School Name:

First name:

Last name:

Home phone:

* OK to call here

Cell phone:

OK to call here

Email address:

Relationship:

Relatives

Please list any relatives that are currently employed by or volunteer at Valley Medical Center.

1

2

First name:

Last name:

Relationship:

Email

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 check boxes below to select the kinds of email you would like to receive from us.

Email address:

What kinds of email would you like to receive?

Electronic newsletters

Volunteer Department Updates

I Agree

I understand and agree that submitting this application form does not automatically register me as a Valley Medical Center volunteer, and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering.

By submitting this form, I attest that the information I have provided on the form is true and accurate.

I Agree