Volunteer Resources Application

* indicates required field

What Volunteer Opportunities are you interested in? * Coffee Cove Cashier*
Emergency Department Volunteer*
Errand & Escort Volunteer
Gift Shop Volunteer*
Main Lobby Information Desk Volunteer
Same-day Surgery Volunteer*
Security Department Volunteer*
Other Support Areas (Clerical, Filing, Data Entry, Special Events, etc...)

* Indicates that volunteers must be 18 years and older

Availability

Mornings? * YesNo
MonTuesWedThurFriSatSun

Afternoons? * YesNo
MonTuesWedThurFriSatSun

Evenings? * YesNo
MonTuesWedThurFriSatSun

Contact Information

First Name *

Last Name *

Email *

Primary Phone *

Street Address *

City *

State * Please select state... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, DC West Virginia Wisconsin Wyoming

Zip Code *

Birthdate (optional)

College Information (If Applicable)

College Address if applicable. House # and street as well as dorm and room #

City

State Please select state... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, DC West Virginia Wisconsin Wyoming

Zip Code

Referred by (if applicable)

Educational Information

Are you attending classes now? * YesNo

Name and location of school

High School

Graduate? YesNo

College / University

Graduate? YesNo

Emergency Information

Person to be notified in the event of an emergency:

Name *

Relationship *

Address *

City *

State * Please select state... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, DC West Virginia Wisconsin Wyoming

Zip Code *

Primary Phone *

Work Experience

List most recent experience first.

Organization #1

Name of Organization

Type of Work

From (approximately)

To (approximately)

Organization #2

Name of Organization

Type of Work

From (approximately)

To (approximately)

Volunteer Experience

List most recent experience first.

Organization #1

Name of Organization

Type of Work

From (approximately)

To (approximately)

Organization #2

Name of Organization

Type of Work

From (approximately)

To (approximately)

Personal References

Family members are not acceptable references. By submitting this application, you grant the Volunteer Resources Office permission to contact your references. Criminal background checks will also be performed on applicants ages 18 and over.

Reference #1

Name *

Phone *

Email *

Relationship *

Reference #2

Name *

Phone *

Email *

Relationship *

What/who has motivated you to seek volunteer opportunities at Holland Hospital? *

What strengths do you possess that will enhance the quality of care given to our patients, family members, and visitors? *

What do you hope to achieve from your volunteer experience? *

Miscellaneous

Have you ever been convicted of a misdemeanor or felony? * YesNo

Please explain your misdemeanor or felony *

Are you volunteering to satisfy school-required community service? * YesNo

Please document the number of hours required *

* Please be aware that no court ordered community service will be accepted. Applicants with misdemeanors within the past 5 years or felonies within the last 10 years will not be considered. *