To apply to become a Volunteer, please complete this application form and click the CONTINUE button at the bottom


Basic Information

Emergency Contact

Please provide the name, relationship, home, work and/or cell phone #s of who we should contact in case of emergency



Employment

Relevant Specialized Skills

Volunteer Experience

Volunteer Service

Specific Program Interest

Availability

Please note - we ask for a 6 month commitment of service. Exceptions can be made for school breaks. Please let us know what days and time you prefer to volunteer.



Criminal Background Check

Northern Light Eastern Maine Medical Center will conduct a criminal background check on all new volunteers.

Please consider carefully: Have you ever been convicted of a crime or pled guilty, NOLO, or no contest? (Conviction of a crime does not necessarily disqualify the applicant from consideration. A crime includes the conviction of a Class A, Class B, Class C, Class D, or Class E crime in Maine, or a misdemeanor or felony in another state.)



Criminal Background Check (cont)

Is there a criminal action pending against you?



References

Please provide names of two people who are not related to you with the daytime phone number and e-mail address for each person.



Acknowledgement and Commitment

Commitment

Northern Light Eastern Maine Medical Center provides volunteer opportunities to qualified applicants without regard to race, color, religion, sex, age, ancestry or national origin and mental or physical disability. No question on this application is intended to secure information to be used for discriminatory purposes.


Volunteer position offers are contingent upon:

1. Receipt of acceptable recommendations from references.

2. Departmental or program leader approval.

3. Completion of the Volunteer Health Screening and release, including TB screening

and Rubella, Rubeola. Mumps and Chicken Pox immunizations (if needed).

4. Criminal background check

5. Compliance with COVID-19 and Flu Vaccination Policy


I understand that I will discuss with Volunteer Services all reasonable accommodations I may need in order to perform the duties required by the volunteer position I am offered.


Consideration for certain volunteer positions requires additional screenings and will be discussed at time of offer.


The information provided by me on this application is correct and complete to the best of my knowledge and belief. I understand that any false or misleading statements made on this application may result in refusal of my volunteer service.


I authorize the Medical Center to verify any information in the application and to contact my references.