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:

Prov Affil #::

Street 1:

Street 2:

City:

State:

* 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:

T-Shirt size:

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:

Gender:

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:

School:

High school:

Availability

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

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:

Work phone:

Relationship:

Employer

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

Employer name:

First name:

Last name:

Title:

Street 1:

City:

State:

Zip:

Home phone:

OK to call here

Work phone:

* OK to call here

Email address:

Relationship:

Contacted:

Verified:

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