NCMC Volunteer Application

Thank you for your interest in becoming a volunteer at North Colorado Medical Center. Once we receive your completed application, we will be in touch to set up an an appointment for an interview. If you are submitting your application electronically, please select "continue" at the bottom of this form to send your application to the NCMC Volunteer Services Department.

Applicant Information

Please add your emergency contact numbers in box 1-2

First name:

Last name:

Middle name:

Nickname:

Street 1:

Street 2:

City:

State:

* Zip: *

Primary phone phone:

OK to call me here

Cell phone:

OK to call me here

Email address:

Referral Source:

Date of birth if under 18 years:

Employment Experience

Please summarize your current and past employment experience.

Volunteer Experience

Please summarize your current and past volunteer experience.

Making a Difference

In a few sentences, describe why you are interested in volunteering with our organization.

Assignment Preference

Please share your areas of interest for volunteer service.

Service Availability

The initial commitment expectation for all volunteers is 100 hours over 6 months of service. Please share the days and times of the week you are currently available to volunteer.

Felony Disclosure

Have you ever been convicted of a felony?

* Please answer yes or no:

Yes

If yes, please explain.

Certification of Information

I certify the statements made in this volunteer

application are true and correct, and have been

provided voluntarily.

• I understand that my time and services are donated to

Banner Health without contemplation of future

employment and also understand that I will not be paid

for my services as a volunteer.

• I understand that prior to the onset of service, I will

be required to:

o Attend an Informational Meeting

o Complete Criminal Background Screening

o Complete Occupational Health Screening

o Attend a New Volunteer Orientation session

o Complete any additional training required by my

assignment.

• I understand the misrepresentation and/or withholding

of information may result in the rejection of this

application or cause my dismissal if discovered after

volunteer service begins.

I Agree