IMPORTANT UPDATE: Thank you for your interest in volunteering at UChicago Medicine! Please note that due to the growing concern of COVID-19 (coronavirus) in the United States, there may be some delay with processing and reviewing your volunteer application. Our team will reach out to you in the near future. If you have additional questions or concerns, please contact volunteers@uchospitals.edu.

Thank you for your interest in volunteering at the University of Chicago Medicine Center for Advanced Care in Orland Park. We are looking for volunteers that will help welcome, guide, and provide comfort to our patients and visitors as well as support our staff with various tasks.

Please complete this form to apply to become a volunteer at our Orland Park facility. Any field with an asterisk (*) is required.

Applicant Information

You must be at least 16 years of age to volunteer and commit to our volunteer requirements (at least 100 hours and six months of service) to volunteer at the Center for Advanced Care in Orland Park.

You must be able to volunteer for at least four hours Mondays between 7am-8pm and Tuesdays-Fridays between 7am-5pm. Weekend opportunities are currently not available.

Volunteer opportunities are not available to B-1, B-2, H1-B and H-4 visa holders. Applicants with permanent resident cards must provide a copy of their card to our office during the time of the interview.

First name:

Last name:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Home phone:

Cell phone:

Email address:

Date of Birth:

Do you have a SSN?:

Are you a US Citizen?:

Type of Visa (if applicable):

* How did you hear about us?:

Demographic Information

This section is optional and used only to help us understand the demographics of our volunteers.

Gender:

Ethnicity:

Emergency Contact

Please indicate who we should contact in case of an emergency.

First name:

Last name:

Home phone:

Work phone:

Cell phone:

Relationship:

Education and Training

Please select the highest level of education or training you have completed.

Education:

Education Institution:

Employment Information

Please provide information about your current employer (if applicable).

Current Employer:

Current Position:

* Have you been employed at UCM?:

Yes

Volunteer Experience and Skills

List any prior volunteer experience and special skills, interests or hobbies you would like to apply to your volunteerism.

Availability

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

Why do you want to volunteer with us?*

Other Information

Have you ever been convicted of a criminal offense other than minor traffic violation(s)? A "Yes" answer will not necessarily result in your disqualification.

* Answer to criminal offense question:

Yes

If you have been listed or used another name other than the one listed on your application, please provide in the space below.

Disclaimer and Agreement

I affirm that the information provided in this application is true and complete to the best of my knowledge. I understand that volunteer applicants will undergo a criminal background check. I consent to take the prevolunteer physical health screening and any such future screening(s) as may be required by the University of Chicago Medicine. I agree to follow hospital policies and procedures for volunteers as outlines in the Volunteer Handbook. I understand that volunteers are not covered by Workers Compensation and that I am responsible for maintaining my own health insurance. I voluntarily offer my services with a clear understanding there will be no monetary compensation and that volunteering does not lead to employment.

I understand and agree that submitting this application form does not automatically register me as a University of Chicago Medicine volunteer, and that there may be certain qualifications I must meet including the acceptance of established volunteer policies and procedures before I may begin volunteering.

I agree to volunteer no less than four hours per week for a minimum commitment of at least 100 hours over a 6-month to one-year time period. Note that staff will only sign off to verify a volunteer's hours once the 100-hour and six months commitment has been fulfilled.

I Agree