Please complete this application form if you are interested in becoming a Dr. P. Phillips Hospital volunteer. Once you complete the form, click the submit button at the bottom.


Name and address


Demographic Information

You are required to provide the following information. Some information may be used to complete a mandatory background check.



Education Background

If you are currently attending school please indicate the name of the school and your degree program.



References

Please list the full name, mailing address and email address for three references. Include any combination of personal and professional reference sources; RELATIVES MAY NOT BE LISTED AS REFERENCE SOURCES. Your application WILL NOT be processed without complete information.



Past Work Experience

Please list the most recent name and address of your past employer. Also, list the name of your most recent supervisor/leader.



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.



Skills & Experience

Please list any special skills or talents that you would like to share with us.



Availability

Please indicate the days and times that you would like to share with us.



Emergency Contact Information

In the event of emergency, who do you prefer we contact.



Criminal Background History (Yes/No)

Have you ever been convicted in a court of law, pleaded nolo contendre, been placed on probation, or had withheld to an offense other than a minor traffic violation? Note: Application will be considered incomplete if not filled in. Type in "N/A" if there are no convictions and if yes, please explain.