Name and Address

First name:

Last name:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

* OK to call me here

Work phone:

OK to call me here

Cell phone:

Email address:

Demographic Information

The section is used only to help us place our volunteers in the appropriate age restricted departments. ***Please note that the minimum age to volunteer is 15 years old and applications will not be accepted for those under 15 at the time of application.

Date of birth:

Age range:

Gender:

Education:

Availability

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

Program Preference:

Sun

Mon

Tue

Wed

Thu

Fri

Sat

From:

To:

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

Communication (Required)

Emergency Contact Information

First name:

Last name:

Street 1:

Street 2:

City:

State:

Zip:

Home phone:

Work phone:

Cell phone:

Motivation for Volunteering

Please summarize why you are interested in volunteering at Regions Hospital or HealthPartners and what you hope to gain from your volunteer experience. (Please write in complete sentences)

Previous Volunteer Experience

Do you have any previous volunteering experience? If yes, please list duties and responsibilities. (Please write in complete sentences)

Department Preferences

Are you interested in volunteering in a particular department or clinic? Please write what department and why you are interested.

Additional Information

How did you hear about us?:

Thank you for taking the time to complete this online volunteer application for Regions Hospital and HealthPartner Clinics.

By checking this box you are indicating that the information provided is accurate to the best of your knowledge. You are also indicating your approval for us to perform a State of Minnesota Background study.

Failure to fully and truthfully complete this application may result in denial of volunteer service or termination from service. Regions Hospital and HealthPartners Clinics Volunteer Department are not obligated to provide placement, nor are you obligated to accept the position offered. Regions Hospital and HealthPartners Clinics Volunteer Department reserves the right to place volunteers in the area we feel is best suited to their skills and the needs of the hospital. Please note that while Volunteer Services staff can provide confirmation of hours served, we cannot sign off on or serve a site supervisors for internships, practicums or contact hours.

By agreeing to this form you are agreeing that you are aware that the process for volunteering includes these steps:

- Interview

- Reference form completion

- DHS background study

- Orientation

- Health Screening (which can include up to three visits to our Employee Health and Wellness dependent on immunization history and tuberculosis test results)

- Purchase of a uniform shirt ($11)

Volunteering cannot commence until an applicant completes all steps in the process, which generally takes between three to four weeks to complete.

I Agree