Fill in your full legal name below. This information will ensure the accuracy of processing your background check as part of the volunteer application process.

Enter your valid Social Security number for identifier purposes. Applications without a valid Social Security number will not be processed. Our Volgistics database has security measures in place to keep your information safe.

Are you a current or previous University Health employee?

Please provide the name of the person to contact in case of an emergency.

Tell us what draws you to the ministry at University Health.

Please check your volunteer area of interest. Some of these vocations require education and approval prior to acceptance to the program.

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

How did you learn about our University Health Spiritual Care Volunteer Program? Please name the source

Please provide us with two references(employer, volunteer manager, church leader, etc). Please provide your supervisor's name and contact information.

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 checkbox below to select the kinds of email you would like to receive from us.

Your date of birth is requested only for the purpose of obtaining a consumer report. Your response to the requested information is voluntary, and refusal to provide the information will not subject you to any adverse treatment. Your assistance in providing the information on this form will be greatly appreciated and will be kept confidential. Please be advised that this form will be separated from, and is not a part of, your official application for volunteer acceptance.

Note: A consumer report may consist of employment records, education verification,licensure verification, driving history,previous address, and other public records relative to criminal charges. A credit report will not be requested unless it is deemed pertinent to the functions of the position for which you are applying.

I have read the above notice and understand what it means. I hereby authorize the procurement of a consumer report for volunteer purposes. Pursuant to the requirements of the Fair Credit Reporting Act, notice is given that a consumer report may be made in connection with your application for acceptance.

If you are denied, either wholly or partly, because of information contained in a consumer report, a disclosure will be made to you of the name and address of the consumer reporting agency making such report. You will also receive a copy of the report and a statement of your consumer rights.