Volunteer Application Form

Please complete this application if you are interested in becoming a volunteer at Children's Hospital Colorado. Once you have completed the form, click the "continue" button to transmit the application.

Name and address

Employer/School Name, Address, and Phone Number

Emergency Contact

First name:

Last name:

Home phone:

Work phone:

Cell phone:

Availability / Areas of Interest

Please indicate your location preference

By using the scale from 1 – 4 below, please rate your location preference:

(1 = top choice; 2 = second choice; 3 = third choice; 4 = last choice)

Hobbies / Skills

Bilingual: If yes, Please List Languages

Past Volunteer Experience: If yes, Please Describe

Referred By: Please check One Box and List Name

List Two References (not including relatives).

Please note that both references will be contacted.

1

2

First name:

Last name:

Home phone:

Work phone:

Cell phone:

Email address:

Please include relationship for each reference in this box.

Diversity

It is our intention that all qualified applicants be given equal opportunity. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation.

As an affirmative action employer under E.O. 11246, we invite all applicants to identify themselves as indicated below. The following questions are voluntary and in no way affect the decision regarding your application. This is confidential information.

If you choose to provide the following details, each question must be fully and accurately completed.

Please choose one of the following:

I choose not to answer:

I decline to provide my diversity

Privacy Release Authorization for 18 and older

The following release authorization is for volunteers 18 years of age and older.

I certify that all information in this application is true and complete. I understand that any false information or omission may disqualify me from further consideration for volunteer service and may result in my dismissal if discovered at a later date.

I understand that Children’s Hospital Colorado requires certain information both personal and professional from me to evaluate my qualifications and consider me for volunteer service. I understand that in consideration of my application, a background investigation may be conducted. I authorize and release all past and present employers, personal references and any other organizations to answer all questions asked concerning my previous employment and/or volunteer record, ability, character, educational background and military service.

In consideration of my application for volunteer service, I authorize Children’s Hospital Colorado and all associated entities to conduct such an investigation and release all before mentioned companies from any liability or responsibility for this investigation, which may include, but is not limited to, the performance of medical examinations, drug screening, reference verification and military service in the files of any state or local criminal justice agency. I understand that any information requested is for the sole purpose of gathering information accurately for use in the above mentioned employment and background check.

I have read and understand the above, and by my signature, consent to these statements.

Applicant Signature/Date_______________________________________________

Interviewer Signature/Date______________________________________________

I Agree