Adult Volunteer Application

Please complete all sections below. (*Education section is for students only.) All fields highlighed in green or with an [*] are required to successfully submit your application. Thank you for your interest in volunteering with us!

Personal Information

* First Name

Middle Initial

* Last Name

* Date of Birth

* E-mail

* Phone (Home)

* Phone (Mobile)

* Home Address

Apt #

* City

State

* Zip Code

Education (For Students ONLY)

Highest level of education completed

Are you currently enrolled as a student?

Name of High School/College attended/attending

Degree/Major

Employment Information

Are you currently or recently employed?

Are you a Providence St. Joseph employee?

*If yes, indicate your job title and department

* Can you perform the essential functions of tasks with or without reasonable accomodations?

Volunteering at Providence St. Joseph Hospital

How did you learn/hear about our program?

* Why do you want to volunteer and what experiences are you expecting from this program?

Do you have any skills/talents or interests you would be willing to share with us?

Were you referred by a Providence St. Joseph Hospital staff or Volunteer?

In order for your application to be considered, please indicate specific hours of availability.

The majority of the shifts are four hours each.

Please do not submit availabilities that may change within the next six months.

REMINDER!

As a Volunteer we ask that you commit to 100 hours with one-four hour shift each week.

Volunteer placement depends upon the needs of Providence St. Joseph Hospital.

Previous Volunteer Experience

Have you ever submitted a volunteer application or volunteered at other organizations?

*If yes, please share when, where, and what your role was

Availability

(Please note there are very limited openings on weekends)

Please select your day(s) of availability.

Please select your time availability.

*If you selected 'other availability' please add times here.

* Please list your top (3) department or unit choices to volunteer in. *See Volunteer Opportunities list in the 'News' section on the 'How to Apply' page / Rank your selections (top choice should be listed first).

Emergency Contact Information

* Contact Name

* Relationship

* Phone (Home)

PLEASE ELECTRONICALLY SIGN YOUR NAME BELOW BY TYPING IN YOUR NAME.

By signing, you are acknowledging you have submitted the correct information above.

FAILURE TO COMPLETE THIS STEP WILL RESULT IN AN INCOMPLETE APPLICATION.

* Electronic Signature

Providence St. Joseph Hospital Orange

VSys Web application

Personal Information

Education (For Students ONLY)

Employment Information

Volunteering at Providence St. Joseph Hospital

Previous Volunteer Experience

*If yes, please share when, where, and what your role was

Availability

Emergency Contact Information

Personal Information

Education (*For Students ONLY*)

Employment Information

Volunteering at Providence St. Joseph Hospital

Previous Volunteer Experience

*If yes, please share when, where, and what your role was

Availability

Emergency Contact Information

Education (For Students ONLY)