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McLaren Health Care - Hospitals in Michigan|Volunteer At McLaren Health Care|Volunteer - McLaren Port Huron|Online Volunteer Application

Online Volunteer Application

Volunteer

Volunteer At McLaren Health Care

Port Huron - Volunteer Application

Note: Fields marked with an * indicates required field

Personal Information

First Name: *

Last Name: *

Date: *

Address: *

Address 2: *

City: *

State: *

Zip Code: *

Home Phone - Please use xxx-xxx-xxxx format: *

Work or Cell Phone - Please use xxx-xxx-xxxx format: *

Email: *

How did you hear about our Volunteer Program? *

Are you under 18 years old? *

Yes

No

Birthdate

Birth Month: *

/

Birth Day: *

/

Birth Year: *

Education Completed

Education Completed - High School: *

1

2

3

4

Education Completed - College: *

College:

1

2

3

4

Education Completed - Post Grad: *

Post Grad:

1

2

3

Are you currently a student? *

Yes

No

Name of School: *

Grade: *

Major field of study: *

Is Volunteer work a class assignment? *

Yes

No

Internship required for graduation? *

Yes

No

Employment Experience

Are you currently employed? *

Yes

No

Employer: *

Hours per Week: *

Are you job hunting? *

Yes

No

Past Employment History (list most recent)

Employer: *

Position Held: *

Date - Start: *

Date - End: *

Reason for Leaving: *

Employer: *

Position Held: *

Date - Start: *

Date - End: *

Reason for Leaving: *

Professional References (please provide two references we may contact other than a relative)

Reference: *

Reference Phone: *

Relationship: *

Reference: *

Reference Phone: *

Relationship: *

Availability

Sunday: *

8-12 12-4 4-8

Monday: *

8-12 12-4 4-8

Tuesday: *

8-12 12-4 4-8

Wednesday: *

8-12 12-4 4-8

Thursday: *

8-12 12-4 4-8

Friday: *

8-12 12-4 4-8

Saturday: *

8-12 12-4 4-8

Anticipated length of Volunteer service: *

Areas of Volunteer Interest: *

Office and Clerical Gift Shop Information Desk
Patient Transport Skylight Cafe Surgical Waiting Area
Other

Areas of Volunteer Interest - Other: *

Other:

Special skills and interests - computer skills, public contact, office setting, etc: *

Reason you would like to become a hospital volunteer: *

Background

Previous Volunteer experience: *

Are you volunteering to fulfill community service obligations? *

Yes No

If yes, list your probation officer

Have you ever been convicted of any crime or held responsible for any civil infraction? *

Yes No

Are there any felony proceedings pending against you? *

Yes No

If you answered yes to either of the previous two questions, please explain: *

Please list any friends/relatives employed at McLaren Port Huron:

Friend Name: *

Position: *

Department: *

Relationship: *

Friend Name: *

Position: *

Department: *

Relationship: *

Friend Name: *

Position: *

Department: *

Relationship: *

Captcha*

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