IU Health Arnett, IU Health Frankfort & IU Health White Memorial Volunteer Application

Thank you for your interest in volunteering at IU Health. Please complete this application form if you are interested in becoming a volunteer at IU Health Arnett, IU Health Frankfort, or IU Health White Memorial.

Indiana University Health considers all applicants for volunteers in accordance with State and Federal Laws and does not discriminate on basis of age, religion, race, sex, national origin or disability.

PLEASE NOTE: Volunteers are required to be 18 years of age or older. Items marked with asterisk (*) are required.

Click the Continue button at the bottom of this form once complete.

Contact Information

Please enter your name, address, telephone number, and email address.

Demographic Information

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

Date of birth:

Gender:

Education:

Availability

Please indicate your availability.

Preferences

* Volunteer Site:

IU Health Arnett

IU Health Frankfort

IU Health White Memorial

Tell us which areas you are interested in volunteering: Ambassadors/Greeters, Events, Emergency Department, Fundraising, Gift Shop, Patient Care Area, Surgery Waiting Area

References

List two people other than relatives who would be willing to serve as personal references. By providing the references listed on this application, I hereby authorize them to provide any information they may have regarding me and release them from all liability.

1

2

First name:

Last name:

Title:

Street 1:

City:

State:

Zip:

Relationship:

Work phone:

* OK to call here

Work phone:

* OK to call here

Email address:

Emergency Contact

This person will be notified in case of emergency.

First name:

Last name:

Street 1:

City:

State:

Zip:

Home phone:

Cell phone:

Email address:

Relationship:

Agreement

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as an Indiana University Health volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.

I hereby authorize Indiana University Health/IU Health Volunteer Services to verify, obtain copies of records and gather any information pertaining to my submitting a volunteer application with IU Health/IU Health Volunteer Services. My submission of this application authorizes IU Health/IU Health Volunteer Services to request written verification as needed.

I understand the receipt of this application does not imply that I will be offered a position as a volunteer. If accepted as a volunteer, I agree to abide by all IU Health rules and regulations.

I understand that my volunteer position is at the discretion of IU Health/ IU Health Volunteer Services and can be terminated at any time with or without cause, and/ or notice.

I Agree