Volunteer Application Form
Please complete this application form if you are interested in becoming a volunteer with Fairview Range Volunteer Services Organization at Fairview Range Medical Center. Once you complete the form, click the submit button at the bottom.
Name and address
First name:
*
Last name:
*
Nickname:
Street 1:
*
Street 2:
City:
*
State:
Choose
AK
AL
AR
AZ
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WY
*
Zip:
*
Home phone:
Work phone:
OK to call me here
Cell phone:
OK to call me here
Demographic Information - Birthdate
You must be at least 18 years old to volunteer.
Date of birth:
Month
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Year
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1917
(year optional)
Email Preferences
We routinely use email to communicate with our volunteers; however, we 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
Announcements
Work History
List your current or most recent employer, job title, and duties.
Employer name:
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
Work phone:
OK to call here
Current or most recent job title, and duties.
Previous volunteer experience
List any previous volunteer experiences you have had.
I want to volunteer at Fairview Range because
Availability
Use the checkboxes to indicate the days and times you are usually available to volunteer
Sun
Mon
Tue
Wed
Thu
Fri
Sat
Morning:
Afternoon:
Evening:
Assignment Preferences
Use the checkboxes below to show which assignment areas you may be interested in. You may choose more than one. Click on the assignment to learn more about job duties, qualifications, and availability. If you are open to any assignment, leave blank.
Assignment Preference:
Concierge [Fairview Range Medical Center\Volunteer Services]
Gift Nook [Fairview Range Medical Center\Volunteer Services]
Guest Services [Fairview Range Medical Center\Volunteer Services]
Information Assistant [Fairview Range Medical Center\Volunteer Services]
Leadership [Special Projects\Volunteer Services]
North Entrance Information Desk Receptionist [Fairview Range Medical Center\Volunteer Services]
Patient & Family Waiting area [Fairview Range Medical Center\Volunteer Services]
Pet Therapy [Fairview Range Medical Center\Volunteer Services]
Service Projects [Special Projects\Volunteer Services]
Special Projects [Special Projects\Volunteer Services]
Student/Job Shadowing (100 + hours) [Special Projects\Volunteer Services]
References
Two (2) references are required. Please provide names and phone numbers of 2 non-relatives. References will be checked before orientation is scheduled.
1
2
First name:
*
First name:
*
Last name:
*
Last name:
*
Home phone:
*
Home phone:
*
Cell phone:
Cell phone:
Emergency Contact Information
First name:
*
Last name:
*
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:
Cell phone:
OK to call here
Relationship:
Choose
Co-worker
Daughter
Father
Friend
Mother
Neighbor
Son
Spouse
Supervisor
Terms and conditions for applying
The information submitted in this application is true and accurate to the best of my knowledge. If approved for consideration, I understand I will be expected to abide by the policies and standards of Fairview Range Medical Center. Prior to my placement in a volunteer position, I understand that I will have to attend a new volunteer orientation, submit a background study form as required by law, and complete a pre-placement interview and health screening.
I Agree
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