This application is for the Auxiliary only. If you are looking to be a student volunteer please select that form. If it is not available to select then we are full at this time, please check back as we will reopen it as positions become available. If you are a student and you use this application to apply it will be deleted. Please complete this application form only if you are 21 and older and are NOT seeking employment with Desert Valley Hospital but are interested in becoming a Desert Valley Hospital volunteer. Once you complete the form, click the submit button at the bottom. Thank you!

Name and address

First name:

Last name:

Title:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

Home phone:

OK to call me here

Cell phone:

OK to call me here

Email 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.

Date of birth:

Gender:

Education:

School:

High school:

College:

Availability

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

Email Preferences

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

What kinds of email would you like to receive?

Electronic newsletters

Recruitment appeals

Emergency Contact

First name:

Last name:

Home phone:

OK to call here

Cell phone:

OK to call here

Relationship:

References

1

2

First name:

Last name:

Home phone:

OK to call here

Home phone:

OK to call here

Cell phone:

OK to call here

Cell phone:

OK to call here

Relationship:

Student Status

Experience

Are you related to any employees of DVH or DVMG?

1

2

First name:

Last name:

Title:

Relationship:

Commitment

Why do you wish to volunteer at DVH?

I Agree

I understand that my references will be contacted and that any incorrect information on this application intentional or otherwise could be used as a reason to deem me unfit to serve as a volunteer at Desert Valley Hospital.

I Agree