Beacon Health System Form Site | Beacon Kalamazoo Volunteer Services

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Why do you want to volunteer?*

Have you ever been discharged from employment? (Optional)

No
Yes

Have you ever been terminated from volunteering? (Optional)

No
Yes

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

What about the health care setting is appealing to you?*

Availability

When are you available to start?*

If you will only be volunteering for a specific period of time, please specify an end date.*

We offer volunteer opportunities seven days a week. Please list your general availability for each day of the week. Please specify a.m. and p.m.

Are you a student?*

No
Yes

Documentation

Will you require documentation of your volunteer experience*

No
Yes

Is volunteering a part of any academic requirement?*

No
Yes

Are you volunteering to satisfy a court-required community service?*

No
Yes

Have you ever been convicted of a crime?*

No
Yes

Are there any felony charges pending against you?*

No
Yes

Current Employment

Are you currently Employed?*

No
Yes

Volunteer Experience

Do you have prior volunteer experience?*

No
Yes

References

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Relationship to Reference*

Daytime Phone Number*

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Relationship to Reference*

Daytime Phone Number*

Accept Terms of Application

Signature (Full Name)

Today's Date*

Consent*

I agree to the privacy policy.

Terms of Application

Beacon Health System offers equal opportunity to all, based upon individual merit and without regard to race, color, religion, national origin, sex, age, height, weight, familial status, marital status or disability, which needing accommodation may be reasonable accommodated as required by law.

I hereby affirm that the responses on this document are true to the best of my knowledge. I agree that the information may be verified and references contacted by Beacon Health System. Misrepresentation of facts constitutes cause for separation from Volunteer Services. As a Beacon Health System Volunteer, I understand and agree to:

Uphold the high standards of service excellence maintained at Beacon Health System.
Wear the appropriate uniform
Follow hospital guidelines regarding patient confidentiality

Bacon Kalamazoo : Volunteering form

Availability

Documentation

Current Employment

Volunteer Experience

References

Accept Terms of Application