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McLaren Oakland - Online Volunteer Application Form
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McLaren Oakland - Online Volunteer Application Form
*Indicates required information. If incomplete, will not send.
Date:
*
Name (Last, First, Middle Initial):
*
Address:
*
City-State:
*
Zip Code:
*
Home or Cell Phone:
*
In case of emergency, contact (include name, phone and relationship):
*
E-mail Address:
*
Gender:
*
male
female
Birthday: Month - Day - Year:
*
Are you 18 years of age or under?
*
EDUCATIONAL BACKGROUND
Name of High School
Graduated?
Yes
No
Graduation Year
Name of College:
Degree:
Graduation Year:
Name of Post Graduate School
Degree:
Graduation Year:
Are you a current college student?
Yes
No
PERSONAL INTERESTS/HOBBIES
Please list interests-hobbies:
I am interested in becoming a volunteer because?
I am interested in (check all that interest you)
*
Office Business
Office-Medical
Cardiology
Emergency Room
Medical Imaging
Outpatient Services
Patient Floor
Pharmacy
Surgical Services
Building & Grounds
Nursing Education
Patient Access
Patient Accounting
Other
Referral Source
*
Friend-Relative
Direct Mailk
Recruitment Event
Website
Club-Organization
Newspaper
Self-Inquiry
Other
Current Occupational Status
*
Employed
Homemaker
Retired
Looking for work
Student
What is volunteer level of volunteer commitment are you comfortable making
*
Under 3 months
3 months
6 months
1 year
Availability
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Mornings
Afternoons
Evenings
PRIOR WORK HISTORY
Employer and Position
Telephone Number
Date of Employment
Employer and Position
Telephone Number
Date of Employment
REFERENCES (Other Than Relatives)
Personal Reference (and relationship)
*
Phone Number
*
Email Address
*
Mailing Address
*
Personal Reference (and relationship)
*
Phone Number
*
Email Address
*
Mailing Address
*
Personal Reference (and relationship)
*
Phone Number
*
Email Address
*
Mailing Address
*
Have you ever been convicted of a felony, or have any pending?
Yes
No
If yes, state charge, date, disposition:
I authorize
McLaren Health Care and its affiliates or its designated agents to make whatever inquiries it may deem necessary in connection with my application for volunteer service. As part of such inquiries, McLaren has my permission to contact persons who may have information relating to my suitability to perform volunteer duties.
*
Permission to perform a background check (yes)
Signature
(Typing your name here indicates that all of the above information is accurate and acts as your electronic signature.)
*
If you would like a printed copy of this completed form, please do a file/print before clicking submit.
Captcha*
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