Volunteer Application | Spartanburg Regional

First Name:

Middle Name:

Last Name:

Maiden Name:

Email:

Primary Phone:

Secondary Phone:

Address:

City:

State:

Zip Code:

Social Security Number:

Date of Birth:

Gender:

Location Preference:

If applicable, please indicate if you are applying to a specific volunteer program (for example: pet therapy, etc).

Work and Volunteer Experience

Are you currently employed?

Yes

No

Retired

Have you ever been an employee or volunteer at this facility?

Yes

No

Have you ever been convicted of a crime in this state or any other state other than minor traffic violations?

Yes

No

Do you have a record of founded child or dependent adult abuse in this state or any other state?

Yes

No

Please list any past volunteer or work experiences that you would like us to be aware of.

Have you ever served in the military?

Yes

No

What branch did you serve in?

Spartanburg Regional Healthcare System complies with federal and state disability laws and makes reasonable accommodations for applicants and volunteers with disabilities. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact Volunteer Services.

Organization

Title

Job/Duties

Start Date

End Date

EDUCATION AND TRAINING

Are you a current student?

Yes

No

What school do you attend?

What program are you pursuing?

Are you volunteering to fulfill a school requirement?

Availability

Please list your availability.

References

Please list two people (no relatives) that can speak of your current abilities, skills and talents for volunteering.

First Name:

Middle Name:

Last Name:

Email:

Phone:

Address:

City:

State:

Zip Code:

Relationship:

Years Known:

Reference 2

First Name:

Middle Name:

Last name:

Email:

Phone

Address:

City:

State:

Zip Code:

Relationship

Years Known:

The facts set forth in this application are true and complete. I understand that nothing contained in this volunteer application or in the granting of an interview is intended to create an employment contract. I further understand that my volunteer assignment is contingent upon successful completion of a criminal background check to include child and dependent adult abuse checks. I understand that I will be asked to attend orientation to volunteering and will adhere to all policies set forth by the institution. I understand that if I was born after January 1, 1957, I will be asked to furnish proof of immunization records for Measles, Mumps, and Rubella (MMR) vaccinations. I also understand that I will be asked to complete a Tuberculosis Skin Test if necessary for my volunteer assignment. I understand that this institution is a tobacco free campus, and I will abide by policies governing such. I understand that I will be asked to volunteer for a minimum of six months and up to one year per the requirements of my volunteer assignments.

Yes, I'd like to receive more information about the events and services at Spartanburg Regional Healthcare System.

I have read and agree to the above statements

Full Name:

Date: