Adult Volunteer Application Form

Please complete this application form if you are interested in becoming a Sentara Leigh Hospital or Sentara Cancer Center Volunteer. Once you complete the form, click the submit button at the bottom.

Contact Information

First name:

Last name:

Middle name:

Title:

Nickname:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Home phone:

Work phone:

Cell phone:

Email address:

Date of birth:

(year optional)

Gender:

Emergency Contact Information

In case of an emergency, please list 1 emergency contact.

First name:

Last name:

Home phone:

Work phone:

Cell phone:

Relationship:

Education

Please indicate your highest level of education

Education:

School:

If college, what was your major?

Current Employment

Please list your current employment.

Employer name:

City:

State:

Zip:

Your position and duties:

How did you learn about our Volunteer program?

Availability

Please indicate your availability.

Assignment Preferences

The following volunteer assignments may currently be available. You may click on "Opportunities" from the SLH Volunteer page to learn more these assignments. Rank your assignment preferences below.

Assignment Preference:

1st choice:

2nd choice:

3rd choice:

4th choice:

5th choice:

Skills/Experience

Please check all that apply.

Previous Volunteer Experience

Please list any previous volunteer experience.

Criminal History

* Have you ever been convicted of a crime:

Yes

If yes, please explain.

Adult Volunteer Application

I certify that the information contained in this application is true in all respects. I understand that if any information is found to be false, I am subject to dismissal without notice. (Selecting this box acts in place of your signature for online application.)

I Agree