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Adult Volunteer Application
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Adult Volunteer Application
Today's Date
*
Year
Year
2022
2023
2024
2025
2026
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Month
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Feb
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Jul
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Dec
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Birthdate (MM/DD)
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18 or Older?
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Yes
No
First Name
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Last Name
*
Address
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City
*
State
*
- Select -
Alabama
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ZIP
*
Home Phone
*
Cell Phone
*
Email
*
Preferred Method of Contact
*
Personal Interests - Tell Us About Yourself
Have you volunteered your time and talents at other organizations? If so, what did you enjoy about volunteering?
*
What interests you about volunteering at the hospital?
*
What are your interests and / or hobbies?
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How many hours per week would you commit to volunteering at the hospital?
*
Do you have specific ideas about how you would like to spend your volunteer time? What are they?
*
Education and Work Experience
Current Employer
Work Phone
Position
Responsibilities
Last Grade Completed
High School
- None -
9
10
11
12
Graduation Date
College
- None -
1
2
3
4
Major
Graduation Date
Name of School(s)
Skills / Preferences
*
Domestic (e.g. sewing and crafts)
Public Relations (communication)
Adaptability(variety of assignments)
Delivery(flowers, magazines, puzzles)
Retail / Sales (gift shop, fundraising)
Special Projects(e.g. health fairs)
Volunteer Work Preferences
*
With patients (adult)
With patients (children)
With visitors or families
Independently
In a reception area
Other
Availability
*
Please describe the days and times you are most often available to volunteer. Shifts are available 7 days a week from 8 a.m. - 12 p.m., 12 p.m. - 4 p.m. and 4 p.m. - 8 p.m.
Are you required to volunteer?
*
Yes
No
If yes, by whom?
Hours required
How did you hear about the Volunteer Program?
*
Referred by
Have you ever been convicted, or pled guilty, including a plea of no contest to a criminal offense?
*
Have you ever been convicted, or pled guilty, including a plea of no contest to a criminal offense?
- Select -
Yes
No
If yes, describe
Person to Be Contacted in an Emergency
Name
*
Relationship
*
Address
*
Phone Number
*
List Two Local References
Name
*
Phone Number
*
Name
*
Phone Number
*
If accepted as a hospital volunteer, I agree that:
1. I shall hold as absolutely confidential, all information that I obtain directly or indirectly concerning patients, doctors or staff, and not seek to obtain confidential information. 2. My services are donated to the hospital without contemplation of compensation or future employment, and given with humanitarian, religious or charitable reasons. 3. I shall submit to an annual tuberculin skin test and any other health examination which may be necessary as part of my volunteer services. 4. I agree, as an adult 18 years or older, to submit to the required background screening. 5. I understand I will be required to complete safety education annually. 6. I shall be punctual and conscientious, conduct myself with dignity, courtesy and with consideration of others, and endeavor to make my role as a volunteer professional in quality. 7. I shall make my best effort to fulfill my commitment to the hospital by completing all assignments that I accept. 8. I shall at all times uphold the philosophy and standards of the hospital. 9. I understand that the Volunteer Services Department reserves the right to terminate my volunteer status as a result of (a) failure to comply with hospital policies, rules and regulations; (b) absences without prior notification; (c) inappropriate behavior, work appearance; or (d) any other circumstances which, in the judgment of the department director, would make my continued services as a volunteer, contrary to the best interests of the hospital. I have read each of the above conditions and I agree to be bound by them as well as all hospital policies and procedures with The Valley Health System.
Volunteer Signature
*
Date
*
Year
Year
2022
2023
2024
2025
2026
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
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7
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10
11
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17
18
19
20
21
22
23
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25
26
27
28
29
30
31
Which hospital are you interested in volunteering for?
*
Which hospital are you interested in volunteering for? At this time, Summerlin will not be accepting any volunteer applications until August 15, 2024.
- Select -
Centennial Hills Hospital
Henderson Hospital
Spring Valley Hospital
Summerlin Hospital
Valley Hospital
Valley Health Specialty Hospital
West Henderson Hospital