Please complete each line required on this application. Leaving information incomplete, may disqualify you. If not applicable, please enter NA. Once recieved, we will follow up with you on the next steps to be taken.


NAME AND ADDRESS


PERSONAL 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.



EMERGENCY CONTACT


AVAILABILITY

Please indicate the days and times you will be available to volunteer (Morning 8-12, Afternoon 12-4, Evening 4-8). We require all volunteers to be able to complete a minimum of 1 four hour shift per week consistently.

Hour Requirement:   Adults and Colleges Students - 200 hours Minimum &  Teens - 2 session of 72 hours

No One Dies Alone Volunteers do not have a required set of hours, they will self schedule for Vigils as they become available. 



School Your Currently Attending (if applicable)

Students please tell us the name of the school you currently attend and your expected graduation year. If in college, please list your area of study.



ARE YOU CURRENTLY EMPLOYED:

(Please list the name of your employer and current position)



VOLUNTEER TYPE:

Please list if you are with one of the following programs:

  • Chaplain Program
  • CSUN Intern
  • No One Dies Alone(NODA)
  • Patient Advisory Council
  • Peer to Peer Volunteer
  • STEM Student
  • West Coast University
  • No Program Affiliation


YOUR REASON FOR VOLUNTEERING:

We understand that each volunteer has their own purpose for why they volunteer, what do you hope to achieve by the end of your volunteer time with KP LAMC?



OTHER VOLUNTEER EXPERIENCES:

Describe your previous experience that would assist you in becoming a committed & successful volunteer.



CUSTOMER SERVICE:

Give an example of a time when you provided excellent customer service.



STRENGTHS:

What skills do you have that would make you a good candidate for this position?



Areas of Hospital you would like to volunteer in:


Commitment Promise

The Purpose of the volunteer program is to provide an opportunity to experience working in a hospital environment and to provide needed assistance to the hospital staff, patients and visitors. I desire and agree to volunteer at Kaiser Permanente Los Angeles Medical Center without promise or contemplation of pay or any in-kind benefits or other compensation. I am volunteering for enjoyment, public service, religious or other humanitarian reasons.


I agree to accept the responsibility of the 200 hour commitment over a period of one year to volunteer as an adult, or hour72 hour 2 sessions  as a high school student. The first eight weeks of volunteer service will be as a Red Vest Concierge and it is understood that this is a mutual probationary period. I understand my obligation to attend the required New Volunteer Orientation, Red Vest Orientation, on-the-job training and the annual review meetings.