Dear Applicant,


Thank you very much for your interest in the volunteer opportunities at Elliot Hospital in Manchester, NH.

Please complete this online adult volunteer services application if you are interested in becoming an Elliot Hospital volunteer.

Once you have completed the form, click the CONTINUE button at the bottom.

Your completed application will be screened and reviewed upon receipt in the Volunteer Resource Office. If a potential volunteer position cannot be identified at this time your application will remain on file for six months and will be reviewed if an appropriate position becomes available.

Please do not hesitate to call the Elliot Hospital Volunteer Resources Department at 603-663-2298 if you have any questions.


CONTACT INFORMATION


DEMOGRAPHIC AND REFERRAL INFORMATION


REFERENCES

Please provide TWO references, either personal or professional.

INSTRUCTIONS:

*References must have known you for at least one year.

*References must be over 21 years of age.

*Relatives may not be listed as references.

*Please be sure to provide complete and up-to-date reference contact information for both of your references.

*Your references will be contacted.



EMPLOYMENT INFORMATION - SECTION ONE

If you are currently employed please provide the name of your employer and your role in comment section. If you are retired, what kind of work did you do? Please use comment section to reply.



EMPLOYMENT INFORMATION - SECTION TWO

Are you now or have you ever been an employee of Elliot Hospital or Manchester VNA?

If Yes, check box that applies below.

If Yes, please provide position/role in comment section.



BACKGROUND INFORMATION

1. Have you ever been convicted of or pled guilty or “no contest” to a crime that has not been annulled by a court? Check yes or no below.

If YES, please provide explanation in comment section.

2. Have you ever been charged, indicted, or arrested for a crime which has not been annulled by a court (excluding traffic violations)? Check yes or no below.

If YES, please provide explanation in comment section.



VOLUNTEER EXPERIENCE

Are you now or have you ever been an Elliot Elliot Health System (Elliot Hospital or Manchester VNA) volunteer? Check box below. If YES, What is/was your role? Please provide response in comment section.

Other Volunteer Experience - Past or Present:

Where have you volunteered in the past (or present) other than the Elliot Hospital or Manchester VNA? What is/was your role? Please provide response in comment section.

What do/did you enjoy most about your present/past volunteer experience? Please provide response in comment section.



INTEREST AND PREFERENCE

Why you would like to volunteer with the Elliot Hospital?

If you have a preference please specify your areas of interest or specific department or area in the comments section.



AVAILABILITY

Please identify your preferred day(s) of the week, time(s) of day availability (morning, afternoon or evening) below.

Share any additional information regarding availability in Comments.



AGREEMENT

Please read the following carefully before signing:

I certify that the statements contained on this application are true. I understand that false, misleading or materially incomplete statements on this application are grounds for immediate dismissal as a volunteer. I agree that a thorough investigation of my background may be made and I authorize other persons or organizations to provide any information they have about my background and I release all concerned from any liability in connection therewith. I understand that any offer to serve as a volunteer is contingent on my ability to satisfactorily complete a pre-placement physical examination for the volunteer position to which I have been assigned. I further understand that my volunteerism placement at the Elliot Hospital does not create an employment relationship and may be terminated at any time for any or no reason. I agree to be bound by all applicable policies, rules and regulations of Elliot Health System.

Acceptance for volunteer placement is subject to:
1. Satisfactory reference and criminal background reports.
2. Satisfactory medical history review and required testing.
3. Personal interview with the Director of Volunteer Resources, and volunteer supervisor, as required.
4. Willingness to abide by all hospital requirements and regulations.
5. The needs and requirements of Elliot Health System.

I understand that Elliot Hospital is not obligated to provide a volunteer placement, nor am I obligated to accept the position offered. To the best of my knowledge the information provided in my application is accurate, true and complete. I understand that false, misleading or materially incomplete statements on this application are grounds for immediate dismissal as a volunteer.

By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement.