Please complete this application form if you are interested in becoming a Perham Health volunteer. Once you complete the form, click the submit button at the bottom.


Name and address


Demographic Information

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.


Employment History

In an effort to make your integration into the Perham Health's Volunteer Program as seamless as possible, we would like to know if you have ever applied for a job or held a job with Perham Health.


Immunization Record

Healthcare volunteers are at risk for exposure to serious, and sometimes deadly, diseases. If you work directly with patients or residents, you should get appropriate vaccines to reduce the chance that you will get or spread vaccine-preventable diseases. Protect yourself, your patients/residents, and your family members. Make sure you are up-to-date with recommended vaccines.
Immunization requirements and health screenings must be completed within 90 days of hire (barring medical reasons). If not completed the volunteer may be removed from the schedule until completed. All required vaccinations and health screenings will be offered to volunteers at no cost through the Perham Health Clinic.
Document below if you have had any of the following immunizations:
-Measles, Mumps, Rubella (MMR)
-Varicella and/or Chicken Pox
-Hepatitis B
-Influenza


Availability

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


Assignment Preference

The following volunteer assignments may currently be available. You may click the assignment names to learn more that assignment.


Skills & Interests

Filling this section out will help us find the perfect volunteer fit for you.


Emergency Contact

In the event of an emergency, whom should we notify?


I agree

I certify that the information given by me in this application is true and complete. I understand that any false information, misrepresentation or concealment of fact is sufficient ground for my immediate discharge by Perham Health.

I understand upon agreement of this application I will receive an electronic background check by way of fingerprinting.

Perham Health is an Equal Opportunity Employer and expressly prohibits any form of unlawful volunteer harassment based on race, color, religion, gender, sexual orientation, national origin, age, disability or veteran status.