Adult Volunteer Application-Hospital and Clinic Locations

Please select the location where you would like to volunteer:

Personal Information

* Legal First Name

Middle name

* Family/last name

What would you like to be called? This name will be used for your volunteer badge.

What are your pronouns?

* DOB

* Address

* City

* State

* Zip Code

* E-mail

Which phone number(s) would you like to provide?

Cell Phone

Home Phone

* Cell Phone

* Home Phone

Preferred phone type

Vest Size (a vest will be provided to you as part of your volunteer uniform)

Health Questions

Dietary Restrictions

No Peanuts

Gluten-Free

Vegetarian

Vegan

Dairy Free

Other

Other Dietary Restrictions

Emergency Contact

* Contact name

* Primary Phone

Secondary Phone

* Relationship to Volunteer

Education and Work Experience

What past work or volunteer experience have you found most valuable?

Are you a college student?

What is your area of interest/study?

Approximately when do you plan to graduate?

Are you completing volunteer hours for an educational requirement?

If completing hours for an educational requirement, how many hours must you complete and what is the due date?

Have you ever been employed by Essentia Health?

* Dates Employed:

* Facility/Department

* Your Name at the time

Placement Information

Is there a department or medical specialty you are interested in volunteering in?

Can you commit to volunteering at a regular scheduled time?

When would you be available to start volunteering?

When does your current availability end?

Please note: We ask volunteers for a minimum committment of three months of service. We have limited availability on weekends and evenings. We primarily place volunteers Monday-Friday 8am-4pm.

* Please share any dates and times on which you would be available to volunteer:

* How did you hear about volunteering?

Did you learn about volunteering with Essentia from another volunteer? If so, who referred you?

Why do you want to volunteer with Essentia Health?

To meet people

To help others

To learn new skills

To prepare for my career

Other

* If you selected other, please describe why you would like to volunteer with Essentia Health.

I hereby authorize investigation of all statements contained in this application. I further authorize my reference permission to furnish Essentia Health East with facts and opinions as to my job performance, capabilities and desirability as a volunteer. I further release all persons whomsoever from any damage because of furnishing said information.

* The information in this application is accurate and correct to the best of my knowledge.

* I agree as a volunteer my time and talents will be given freely without any expectation of monetary reimbursement.

I am participating in a community program, which reimburses me for volunteer service hours.

* My typed name shall have the same force and effect as my written signature.

Your Signature

* Signature date

Volunteer opportunities are provided without regard to religion, creed, race, national origin, sexual orientation, age, gender, disability, marital status or status with regard to public assistance. Essentia Health East does not imply that you will be assigned a volunteer position and this application should not be construed as a contract or promise of a volunteer position.

Essentia Health Adult Volunteer Application

Personal Information

Health Questions

Emergency Contact

Education and Work Experience

Placement Information