Volunteer Application Form

Please complete this application form if you are interested in becoming a Hancock Regional Hospital volunteer. Once you complete the form, click the submit button at the bottom.

Name and address

First name:

Last name:

Middle name:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

Cell phone:

Email address:

1. Have you ever been convicted or pleaded guilty to a crime or misdemeanor? If yes, please explain below. (Such acts are not an absolute bar to volunteering, but will only be considered, in relation to specific assignments.)

Availability

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

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.

Date of birth:

Gender:

Education:

Any previous volunteer experience? If yes, what?

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
Here is the Monthy Schedule.If you are unable to volunteer on one of your scheduled shifts please let me know A.S.A.P.
Thanks,
Volunteer Services

Checklist reminders

How did you hear about volunteering at Hancock Regional Hospital?

Emergency Contact

In the case of an emergency, contact:

First name:

Last name:

Home phone:

Cell phone:

Relationship:

Refrence Section

List three references,who are not relatives, prefer employer, former employer, minister, etc.

1

2

First name:

Last name:

Street 1:

Home phone:

Relationship:

3

First name:

Last name:

Street 1:

Home phone:

Relationship:

Do you have any special skills or talents that could be utilized while volunteering at Hancock Regional Hospital?

ACKNOWLEDGMENT

I hereby certify that all information contained in this application is true and correct to the best of my knowledge.

I authorize the investigation of all statements contained in this application as may be necessary in arriving at a volunteer assignment decision, including reference checks and a criminal history background check.

I understand that, in the event of being accepted as volunteer, false and misleading information given through my application or interview(s) may result in discharge.

I Agree