Volunteer Application Form
Please complete this application form if you are interested in becoming a Providence Seaside Hospital Volunteer. Once you complete the form, click the submit button at the bottom.
Contact Information
First name:
*
Last name:
*
Middle name:
Title:
Choose
Dr.
Mr.
Mrs.
Ms.
Prov Affil #::
Street 1:
*
Street 2:
City:
*
State:
Choose
ID
OR
WA
*
Zip:
*
Home phone:
*
OK to call me here
Work phone:
OK to call me here
Cell phone:
OK to call me here
Email address:
Date of birth:
Month
Jan
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Mar
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Jul
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Dec
Day
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*
T-Shirt size:
Choose
Extra extra Large
Extra Large
Large
Medium
Small
Demographics
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.
Age range:
Choose
18 to 64
65 or over
Under 18
Gender:
Choose
Female
Male
Skills & Experience
Please list in the open box any skills or certification that would be beneficial in a volunteer position. Skills do not determine service areas, they simply give our department better background on our volunteers.
Education:
Choose
Associate degree
College degree
Doctoral degree
High school
Masters degree
Some college
Trade/Vocational school
School:
High school:
Availability
Please indicate the days and times you are usually available to volunteer.
Sun
Mon
Tue
Wed
Thu
Fri
Sat
Morning:
Afternoon:
Evening:
Other:
My availability is:
Choose
Ongoing
Ongoing, except between these dates
Only between these dates
From:
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
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
to:
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
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29
30
31
Year
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
I would like to serve up to:
hours:
Choose
Daily
Monthly
One time
Weekly
Emergency Contact
In the event of an emergency whom should we notify?
First name:
Last name:
Title:
Choose
Dr.
Mr.
Mrs.
Ms.
Street 1:
Street 2:
Street 3:
City:
State:
Choose
ID
OR
WA
Zip:
Home phone:
Work phone:
Relationship:
Choose
Co-worker
Daughter
Father
Friend
Mother
Neighbor
Son
Spouse
Supervisor
Employer
Please list your current or most recent employer, if applicable.
Employer name:
*
First name:
*
Last name:
*
Title:
Choose
Dr.
Mr.
Mrs.
Ms.
Street 1:
City:
*
State:
Choose
ID
OR
WA
*
Zip:
Home phone:
OK to call here
Work phone:
*
OK to call here
Email address:
Relationship:
Choose
Co-worker
Daughter
Father
Friend
Mother
Neighbor
Son
Spouse
Supervisor
*
Contacted:
Choose
No
Yes
Verified:
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
2043
2042
2041
2040
2039
2038
2037
2036
2035
2034
2033
2032
2031
2030
2029
2028
2027
2026
2025
2024
2023
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
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 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
Schedule reminders
Checklist reminders
Volunteer Information Center
We provide an online "Volunteer Information Center" where volunteers may check their schedules, update their information, and receive messages. Please select the password you would like to use to access the online Volunteer Information Center.
Please enter a password that:
Is between 6 and 30 characters long
Password:
Confirm password:
I Agree
I understand and agree that submitting this application form does not automatically register me as a Providence Seaside Hospital Volunteer, and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures, a background check and tb screen 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
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