Adult Volunteer Application Form

Thank you for your interest in becoming a volunteer of Crossing Rivers Health! Please complete this form. Then click "Continue" at the bottom.

Once your application has been accepted, you will receive an email informing you of the next steps in the process.

Contact Information

First name:

Last name:

Middle name:

Title:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Home phone:

* OK to call me here

Work phone:

OK to call me here

Cell phone:

Email address:

Demographic Information

Everyone should complete this section.

Date of birth:

Gender:

Emergency Contact

Everyone should complete this section.

First name:

Last name:

Street 1:

City:

State:

Zip:

Home phone:

* OK to call here

Cell phone:

OK to call here

Relationship:

Employment History

Please list your current employer, if applicable.

Employer name:

Street 1:

City:

State:

Zip:

Work phone:

OK to call here

Start date:

Which volunteer opportunities interest you?

Please check all that apply.

Community Events and Projects

Please check any fundraisers, projects and events you are interested in:

My Availabilty

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

Skills & Interests

References

Please list two, non-family references.

1

2

Employer name:

First name:

Last name:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

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:

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?

I Agree

I authorize full and complete investigation of my application information. This process may include interviewing professional and personal references, criminal history verification, and other relevant processes. I understand that any misrepresentation or falsification of this application may constitute rejection or dismissal.

In addition, I do hereby agree to indemnify and hold harmless Crossing Rivers Health, its employees, volunteers or agents from any and all claims or causes of action that may arise out of performance of my assigned duties as a volunteer. I waive any right I have against Crossing Rivers Health in consideration of my participation as a volunteer for the programs and offices of Crossing Rivers Health. In closing, I agree that my volunteer services are donated to Crossing Rivers Health without contemplation of compensation or promise of future employment.

I Agree