Please complete this application form if you are interested in becoming an Alliance Community Hospital volunteer. Once you complete the form, click the submit button at the bottom.

The form will not submit until all boxes with an *asterisk have been completed.


Contact Information

Please complete the following information.


Demographics

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

In the event of an emergency whom should we notify?


Personal References

Please fully complete information for references. Please exclude relatives and others under 18 yrs. old.


Employer

Please list your current or most recent employer, if applicable.


Skills & Experience

In which of these areas do you feel you have moderate to excellent skill? Check all that apply.


Availability

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


Email

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.


Expectations


I Agree

I understand and agree that submitting this application form does not automatically register me as a Alliance Community Hospital volunteer, and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering.

I understand that opportunities for volunteers are provided without regard to religion, creed, race, national origin, age or sexual orientation.

I also acknowledge that the organization is not obligated to provide a placement, nor am I obligated to accept the position. I understand that I am required to abide by all rules and regulations of Alliance Community Hospital and the Volunteer Services Department.
By submitting this form, I attest that the information I have provided on the form is true and accurate.Any misrepresentation would void the applicant from the volunteer program.