Adult Application Form

Please complete this application form if you are interested in applying to become a volunteer at Baptist Health Lexington. Once you complete the form, click the CONTINUE button at the bottom.

Contact Information

First name:

Last name:

Street 1:

Street 2:

City:

State:

Zip:

Primary phone:

Work phone:

Email address:

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

Checklist reminders

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:

* (year optional)

Gender:

Shirt/Uniform Size:

Emergency Contact Information

Please enter the Emergency Contact Information for the person who should be contacted in the unlikely event an emergency occurs while you are volunteering.

First name:

Last name:

Home phone:

Work phone:

Cell phone:

Relationship:

Relatives

Please list the names of any relatives who work (or have worked) at Baptist Health Lexington.

1

2

First name:

Last name:

Relationship:

Availability

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

References

Please identify two (2) references who can give verify your character and dependability.

1

2

First name:

Last name:

Home phone:

Work phone:

Cell phone:

Email address:

Relationship:

Volunteer Interest

Please share why you are interested in volunteering, and why you chose to apply at Baptist Health Lexington.

How You Learned About Program

How did you learn about the Volunteer Program at Baptist Health Lexington?

I AGREE

By submitting this application, I am agreeing to the following if I am selected:

Abide by the Volunteer policies and procedures.

Work in the assigned department(s) of the Hospital.

Purchase and wear the Volunteer uniform prescribed by the Hospital.

Follow handwashing and other hospital sanitation procedures.

Maintain the highest level of confidentiality possibly by discussing patient and other Hospital matters ONLY as my Volunteer assignment requires.

I Agree