McLaren Volunteer Application

Please complete this application if you are interested in becoming a McLaren Greater Lansing volunteer. Once you complete the form, click the submit button at the bottom. IF YOU ARE A STUDENT FROM MICHIGAN STATE UNIVERSITY, YOU MUST APPLY THROUGH COMMUNITY ENGAGED LEARNING AT MSU. YOU CAN DO THIS AT THEIR WEBSITE: www.communityengagedlearning.msu.edu. Registration for Summer Semester will open on May 1st; registration for Fall Semester opens on September 1st, and registration for Spring Semester opens January 4th.

Personal Information

Please fill in all blanks as appropriate

First name:

Last name:

Middle name:

Title:

Nickname:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Home phone:

OK to call me here

Work phone:

OK to call me here

Cell phone:

OK to call me here

Email address:

Demographic Information

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.

Gender:

Marital Status:

Ethnicity:

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

Schedule reminders

Education Information

Education:

Major degree:

Employment Information

If currently employed, please list Employer Name. Otherwise, please list if Unemployed, Retired, or Student.

Employer name:

Emergency Contact

First name:

Last name:

Home phone:

OK to call here

Work phone:

OK to call here

Cell phone:

OK to call here

Relationship:

Volunteer Interests

Please choose at least top three areas that may be of interest to you. This will help in placement of volunteers to our current openings.

Volunteer Availability

Please list days and times you are available to volunteer.

My availability is:

Please list your availability:

Volunteer Commitment Level

Please tell us how long you are looking to commit to volunteering. (Ex: 3 months, 6 months, 1 year)

References

Please list two people who would be willing to serve as personal references. DO NOT LIST RELATIVES OR SIGNIFICANT OTHERS

1

2

First name:

Last name:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

Work phone:

OK to call here

Work phone:

OK to call here

Email address:

Relationship:

Background Check

To protect your privacy, this form will be seen only by McLaren Volunteer Services staff. NOTE: A criminal history will not necessarily disqualify an applicant. A criminal record is one piece of information that will be considered in determining the appropriateness of an individual to be a McLaren Volunteer.

Date of birth:

Drivers License #:

Have you ever been convicted of a felony or misdemeanor? Please type yes or no in the space provided. If yes, also please explain:

Background Check and Consent Section

I give McLaren Greater Lansing permission to check my criminal history with Michigan Law Enforcement Agencies, and to search my history for incidents of fraud with the Fraud and Abuse Control Information Database.

I understand that my enrollment as a volunteer is contingent upon successful completion of the application process. I give my permission for the above-named references to release information about me, for my criminal history to be verified, and to have my history searched for fraud and abuse.

If I am selected as a McLaren Volunteer I agree to abide by all hospital rules, regulations and expectations. I understand that either party may cancel this relationship at any time.

I certify that the above information is correct. I agree to inform McLaren Greater Lansing of any changes.

I Agree

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