Volunteer Application Form
Please complete this application form if you are interested in becoming a Lake Taylor Transitional Care Hospital volunteer. Once you complete the form, click the submit button at the bottom.
Contact Information
First name:
Last name:
Title:
Choose
Dr.
Mr.
Mrs.
Ms.
Rev.
Street 1:
Street 2:
City:
State:
Choose
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
Home phone:
OK to call me here
Work phone:
OK to call me here
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.
Date of birth:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
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25
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27
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29
30
31
Year
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
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1938
1937
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1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
(year optional)
Gender:
Choose
Female
Male
Education:
Choose
Associate degree
College degree
Doctoral degree
High school
Masters degree
Some college
Trade/Vocational school
Uniform Shirt Size:
Choose
01 XXS
02 XS
03 S
04 M
05 L
06 XL
07 2X (XXL)
08 3X
09 4X
10 5X
Skills & Experience
In which of these areas do you feel you have moderate to excellent skill? Check all that apply.
Skills:
Cash Register
Computer Basic
Customer Service
Data Entry
Knitting/Crocheting
Office Work
Patient Assistance
Patient Companionship
Pet Therapy
Repairing Wheelchairs
Telephone Answering
Availability
Please indicate the days and times you are usually available to volunteer.
Sun
Mon
Tue
Wed
Thu
Fri
Sat
From:
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
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Assignment Preference
The following volunteer assignments may currently be available. You may click the assignment names to learn more that assignment. Use this list to rank your top three assignment choices.
Assignment Preference:
Administration Clerical Volunteer [Volunteer Services]
Auxiliary Meeting/Project [Volunteer Services]
Auxiliary Membership [Website]
Azalea Unit Volunteer [Volunteer Services]
Beechwood Information Desk [Website]
Beechwood Reception Desk [Volunteer Services]
Beechwood Unit Volunteer [Volunteer Services]
Beechwood/Azalea Luncheons [Volunteer Services]
Birthday Cart [Volunteer Services]
Blankets-knitted or quilted [Volunteer Services]
Camellia Unit Volunteer [Volunteer Services]
Church Services [Volunteer Services]
Clerical Volunteer [Website]
Concierge Cart Volunteer [Volunteer Services]
Dogwood Unit Volunteer [Volunteer Services]
Donor [Website]
Enviromental Services Clerical Volunteer [Volunteer Services]
Festival of Trees (Sponsor Tree) [Website]
Food Services Clerical Volunteer [Volunteer Services]
Gift Shop Cashier [Website]
Gift Shop Cashier Volunteer [Volunteer Services]
Group Opportunities [Website]
Hair/Nail Care [Volunteer Services]
Health Information Clerical Volunteer [Volunteer Services]
Health Information Clerical Volunteer [Website]
Hospital Level Volunteer [Volunteer Services]
Hospitality Unit Volunteer [Volunteer Services]
Junior Volunteer [Volunteer Services]
Junior Volunteer [Website]
Love Light Tree [Volunteer Services]
Outing Volunteer [Website]
Pastoral Care [Volunteer Services]
Pet Therapy Volunteer [Volunteer Services]
Pet Therapy Volunteer [Website]
Plant Maintenance Volunteer [Volunteer Services]
Recreation Activity Volunteer [Volunteer Services]
Recreation Clerical Volunteer [Volunteer Services]
Recreation Outing Volunteer [Volunteer Services]
Recreation Program Volunteer/Group [Website]
Rehab Reunion [Volunteer Services]
Rehab Services Transporter [Volunteer Services]
Rehab Services Transporter [Website]
Rehab Therapy Student Intern [Website]
Social Services [Volunteer Services]
Special Projects [Volunteer Services]
Unit Hospitality Volunteer [Website]
Unit Visiting Volunteer [Volunteer Services]
Volunteer Services Clerical Volunteer [Volunteer Services]
Wheelchair Rehab [Volunteer Services]
Wheelchair Rehab Volunteer [Website]
Emergency Contact
In the event of an emergency whom should we notify?
First name:
Last name:
Title:
Choose
Dr.
Mr.
Mrs.
Ms.
Rev.
Street 1:
Street 2:
City:
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OR
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PR
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Zip:
Home phone:
Work phone:
Relationship:
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Co-worker
Daughter
Father
Friend
Mother
Neighbor
Poa
Relative
Son
Spouse
Supervisor
Employer
Please list your current or most recent employer, if applicable.
Employer name:
First name:
Last name:
Title:
Choose
Dr.
Mr.
Mrs.
Ms.
Rev.
Street 1:
Street 2:
City:
State:
Choose
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
Home phone:
Work phone:
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.
Email address:
What kinds of email would you like to receive?
Electronic newsletters
Recruitment appeals
Volunteer Information Center
We provide an online "Volunteer Information Center" where volunteers may check their schedules, update their information, and receive messages. Please select the password you would like to use to access the online Volunteer Information Center.
Please enter a password that:
Is between 6 and 30 characters long
Password:
Confirm password:
Personal
Have you ever been convicted of a felony or misdemeanor?
If so, please explain
I Agree
I understand and agree that submitting this application form does not automatically register me as a Lake Taylor Transitional Care 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.
By submitting this form, I attest that the information I have provided on the form is true and accurate.
I Agree
Continue