New User Details
Mercy Health Volunteer Application
MAKE NOTE OF PASSWORD FOR FUTURE USE
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PERSONAL INFORMATION
I prefer to receive phone calls at:
VOLUNTEER EXPERIENCE
Length of Service
Length of Service
WORK EXPERIENCE
Are you currently employed?
Do we have permission to contact your employer?
Employment Status:
Past work experience if applicable:
EDUCATIONAL INFORMATION
Are you currently a student?
Do you speak any other languages?
VOLUNTEER WORK OBJECTIVES
VOLUNTEER GOALS
VOLUNTEER INFORMATION
Please list any relatives or friends working or volunteering for Saint Mary's:
PLACEMENT PREFERENCE
AVAILABILITY
Please indicate your availability to volunteer in the drop boxes below:
Level of commitment:
REFERENCE 1 of 2 (no relatives-MUST provide email and/or phone)
REFERNCE 2 of 2 (no relatives-MUST provide email and /or phone)
OTHER INFORMATION
Commitment of Hours Agreement
If accepted as a Mercy Health Saint Mary's Volunteer, I commit to volunteer at Mercy Health Saint Mary's for a minimum of four hours per
week for six consecutive months or required commitment specified for a designated role or position. By signing in the box below I
recognize that this is the same as my signature and agree to the above agreement.
Authentication and Signature
I authorize investigation of all statements contained in this application and certify that all information is accurate. As a volunteer of
Mercy Health Saint Mary's Volunteer Program, I will be required to follow all personal policies and rules of the hospital and that infractions
of said rules may lead to dismissal. I understand the hospital reserves the right to change, revise, add or delete policies and rules as
necessary, and I will be obliged to conform to such amendments. I understand that the position that I am applying for is an unpaid
volunteer position. By signing in the box below I recognize that this is the same as my signature and agree to the above agreement.
I understand that I may not be selected as a volunteer for any reason, and that if I become a volunteer, my staus may be terminated at any time for any reason.