Please complete this application form if you are interested in becoming a Mary Greeley Medical Center volunteer. Once you complete the form, click the submit button at the bottom.
Please share any special skills, interests or hobbies you have.
Have you ever been convicted of a crime in this state or any other state other than minor traffic violations?
Do you have a record of founded child or dependent adult abuse in this state or any other state?
Please provide information on frequency and days and times you are available.
Please indicate areas where you are interested in volunteering.
Please list two people that can speak of your current abilities, skills and talents for volunteering.
Please do not include relatives.
Please provide contact information for at least one emergency contact.
The facts set forth in this application are true and complete. I understand that:
- nothing contained in this volunteer application or in
the granting of an interview is intended to create an
- my volunteer assignment is contingent upon successful
completion of a criminal background check to include
child and dependent adult abuse checks, which requires
a social security number.
- I will be asked to attend orientation to volunteering
and will adhere to all policies set forth by Mary
Greeley Medical Center.
- I will be asked to furnish proof of immunization
records for Measles, Mumps, and Rubella (MMR)and
Varicella (Chicken Pox)vaccinations if
necessary for my volunteer assignment.
- I will be asked to complete a Tuberculosis Blood Test
if necessary for my volunteer assignment.
- Mary Greeley Medical Center is a tobacco free campus,
and I will abide by policies governing such.
- I will be asked to volunteer for a minimum of six