Ellis Medicine volunteers are an integral part of our organization, giving their time and skills to many areas across the healthcare system. Diverse in age, background and experience, our volunteers continue to provide exceptional care to the community in the most compassionate way.

Please complete this application form if you are interested in becoming a Ellis Medicine Volunteer. Once you complete the form, click the Continue button at the bottom.


Please call the Volunteer Office at 518-243-4009 for more information.


Name and address


Availability

Types of volunteer positions in which you would be interested : (Check one or more) 

Your schedule will be determined based on your availability and the needs of the department.



References

Please include two personal/professional references.



Emergency Contact

An Emergency Contact is required to be listed on your volunteer application.



Background Check


**A background check will be done on all volunteer applicants prior to being appointed to a position at Ellis Medicine**

It is the policy of EllisMedicine to prohibit discrimination on the basis of race, creed, color,religion, sex/gender (including pregnancy), age, national origin, disability(including pregnancy-related conditions), genetic information, predispositionor carrier status, military or veteran status, prior arrest or convictionrecord, marital or familial status, sexual orientation, transgender status, genderidentity, gender expression, reproductive health decisions, domestic violencevictim status, known relationship or association with any member of a protectedclass, and any other characteristic protected by applicable law violatesfederal, state and, where applicable, local laws , reproductive healthdecisions or source of payment, consistent with applicable legislation and tocomply with the laws pertaining thereto. 



Agreement Form

I attest that all the information given in this application is true and I consent to a background check performed at the organization’s expense.  I understand the importance of volunteerism and the work that I will do at Ellis Medicine and will make every effort to notify the Volunteer Department of change(s) of address/contact information, availability, or any other information that I have provided on this form. I understand that my photograph may be used for Ellis Medicine communications and presentations.