Thank you for your interest in becoming a volunteer at St. Luke's! Please complete this application form, clicking submit at the bottom when complete.

Due to high volumes, volunteer applications will be processed after both reference forms have been received. Applications are deleted if the additional required information is not submitted after 3 months.

Name and address

First name:

Last name:

Title:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Home phone:

Work phone:

Email address:

License Plate 1:

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.

Birthday:

Gender:

Education:

Emergency Contact Fields

Please provide an emergency contact person and phone number.

First name:

Last name:

Home phone:

* OK to call here

Cell phone:

* OK to call here

Relationship:

Employer fields

Please provide the your last 3 employers.

1

2

Employer name:

First name:

Last name:

Street 1:

City:

State:

Zip:

Work phone:

OK to call here

Work phone:

OK to call here

3

Employer name:

First name:

Last name:

Street 1:

City:

State:

Zip:

Work phone:

OK to call here

Availability

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

Campus of choice:

Sun

Mon

Tue

Wed

Thu

Fri

Sat

From:

To:

My availability is:

From:

to:

Please share your preferred assignment:

Authorization & Release for Reference Forms

By clicking "I Agree", I hereby grant those I select to complete a reference, permission to complete the reference form and return directly to St. Luke’s without notice to me. St. Luke’s has my permission to investigate my personal, criminal, child abuse, educational and employment background and history and to contact persons, organizations, institutions or government agencies who may have knowledge of me. In consideration for St. Luke’s reviewing my application for a volunteer position, and intending to be legally bound, I hereby release St. Luke’s, its parent, subsidiaries, affiliates, trustees, officers, representatives, employees and agents, from any and all claims or liability, known or unknown, arising from St. Luke’s investigating my background and all persons, organizations, institutions or government agencies supplying such information.

I Agree