Thank you for considering volunteering at St. Louise Regional Hospital. We are excited for you to become a part of our interactive team. Our goal is for you to enjoy your volunteer experience while giving back to the community and our patients. Please complete this application form if you are interested in becoming a St. Louise Regional Hospital volunteer. Once you complete the form, click the submit button at the bottom.

Applicant's Name and Contact Information:

Complete contact information is critical for communication with our volunteers. Please provide all information requested including email, address and phone numbers (home, cell, work) where available


Volunteer Demographic Information:

The following information is used by the Volunteer Service Office only to understand and report on the demographics of the volunteer team


Education:

Provide your educational information and career interests. A comments box is provided below for you to enter text.


Skills and Experience:

Understanding our volunteers skills, experience and competencies helps us better utilize and place our volunteers. Please check the boxes below that apply to you. Additionally there is a comments box below to enter text describing additional skills and competencies you would like to share.


Affiliations:

Are you currently affiliated with any of the following groups or organizations? Select all that apply. There is a text box provided to add affiliations not listed but pertinent. We would also like you to provide a brief explanation of your activities with each of the affiliations you have listed.


Availability:

Please indicate the days and times you are currently available to provide volunteer service. Most volunteer assignments are 4 hour shifts. Maximum allowed volunteer service per week is 20 hours.


Volunteer Program Interest: (Mandatory Field)

Please describe why you are seeking a volunteer position at St. Louise Regional Hospital. Let us know why you are interested in becoming a volunteer and describe what you think you can contribute to our program.


Referrals from St. Louise

Please let us know if you were referred to our Volunteer program by any employee, volunteer or doctor associated with St. Louise Hospital or the County of Santa Clara. Provide their name, contact information, and the relationship you have with this individual.


Personal References:

Please provide contact information on two individuals who can provide a reference for you. We need one personal and one professional contact. Be sure to include at least one phone number where your reference can be contacted and in the comment box below, provide a brief description of your relationship with each of your references. (i.e. John Smith- Personal; Jane Doe- Supervisor XYZ Company.)


Emergency Contacts:

Please provide contact information for two persons who can be contacted in the event you are injured or become ill and require us to contact a family member or close friend to respond.


Terms of Agreement- Adult Volunteers

All Applicants must submit to a background check and have the ability to provide verification of their legal right to work in the United States. This Hospital is hereby authorized to verify the above information.

All applicants must also complete a medical clearance process. We ask that all Adult Volunteers in our programs make a minimum commitment of six (6) months of service in their volunteer assignment. I understand that the Volunteer Service Department reserves the right to terminate my volunteer status as a result of (a) Falsification of application; (b) failure to comply with hospital policies; (c) excessive absences without prior notification; (d) unsatisfactory attitude, work or appearance; or (e) any other circumstance which, in judgment of the Volunteer Service Office would make my continued service as a volunteer contrary to the best interest of the hospital.

I understand that checking the "I Agree" box indicates my permission of St. Louise Regional Hospital to complete the pre-employment background check using the social security number I have provided.