Please select which facility you are most interested in becoming a volunteer at.

Do you have any physical condition or medical diagnosis, which may limit your ability to perform the functions of a volunteer?

Family or Friend we can call in case of an emergency.

If currently employed, provide employer's name and manager's telephone number.

Select all that apply.

Why do you wish to become a volunteer? Do you have any hobbies/interests?

Personal Reference should be someone that is not related to you. If you are between the ages of 16-18 years old, please bring two letters of recommendation to the interview, one from a teacher or faculty member.

To better assist us in determining assignments that are available, please check which day/s of the week and timeframes you are available.

Have you ever been convicted of a felony or a felony that was reduced to a misdemeanor for sentencing purposes including DWI? If yes, state the offense, location, date and disposition.

Believing that Banner Health has a real need for my services as a volunteer, I agree to:
1) Comply with the confidentiality standards regarding all patient information;
2) Uphold the Mission, Values, and Purpose of Banner Health;
3) Endeavor to make my volunteer service the highest quality;
4) Make every effort to fulfill a 4-hour per week shift and six month commitment of service;
5) I understand that Banner Health has a No Flu for You procedure, I agree to follow the requirements;
6) I understand that I am required to attend annual training and in-services, pertaining to my volunteer assignment.
7) I understand that if I am between the ages of 16-18 years old, a completed parent consent form is to be brought to the interview (once scheduled) to become a volunteer, as well as two letters of recommendation, one from a teacher or faculty member.
I understand that my services are donated to Banner Health without contemplation of compensation, or future employment and given for humanitarian or charitable reasons. I verify the preceding information on this application is true. I understand that there are many types of volunteer opportunities with Banner Health facilities, and that I will be required to complete an orientation, employee/volunteer health screening, and additional training that service assignments will require.