Volunteer Resources Application

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

Contact Information

First Name

Last Name

Primary Phone

Address

City

State

ZIP Code

Birthdate (optional)

College Information (If Applicable)

Address

Address 2

City

State

ZIP Code

Referred by (if applicable)

Educational Information

Are you attending classes now?

Yes

Name and location of school

High School

High School Graduate?

Yes

College / University

College / University Graduate?

Yes

Emergency Information

Name

Relationship

Address

City

State

ZIP Code

Primary Phone

Work Experience

Re-order	Name of Organization	Type of Work	From (approximately)	To (approximately)	Weight	Operations
	Name of Organization	Type of Work	From (approximately)	To (approximately)	Item weight

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Volunteer Experience

Re-order	Name of Organization	Type of Work	From (approximately)	To (approximately)	Weight	Operations
	Name of Organization	Type of Work	From (approximately)	To (approximately)	Item weight

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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

Re-order	Name	Phone	Email	Relationship	Weight	Operations
	Name	Phone	Email	Relationship	Item weight

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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?

Yes

Are you volunteering to satisfy school-required community service?

Yes

* 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. *