Online Volunteer Application

Where would you like to volunteer?   *  
 
How were you referred to our organization?   *  
 
Personal Data
Last name:   *
First name:   *
Nickname:  
Email address:   *
Home phone:  
Cell phone:  
Work phone:  
Home address:  
City:  
State:  
Zip:  
Are you over the age of 18?     You must be a minimum age of 16 to volunteer. If you are between the ages of 16-18, a parental consent form will need to be completed prior to volunteering.  
What is your ethnicity?
Are you or have you previously been an employee or volunteer for Franciscan Health System - St. Clare Hospital, St. Francis Hospital, St. Joseph Medical Center or Franciscan Medical Group?    
Are you a student?    
If so, where are you attending school?  
When do you expect to graduate?

Month 

 Year
Do you or have you had any paid or volunteer work experience?    
Please list all current or previous paid or volunteer positions worked in the last five years:
Company/Org
Dates worked
Tasks performed
Reason for leaving

Company/Org
Dates worked
Tasks performed
Reason for leaving

Company/Org
Dates worked
Tasks performed
Reason for leaving

Company/Org
Dates worked
Tasks performed
Reason for leaving
Please provide information for two individuals (non-relative) who can provide a personal or professional reference on your behalf.
Last name:
First name:
Title:
Address:
City:
State:
Zip:
Daytime phone:
How reference knows
you:


Last name:
First name:
Title:
Address:
City:
State:
Zip:
Daytime phone:
How reference knows
you:
If offered a volunteer position at Franciscan Health System, can you provide proof that you are currently legally eligible to work and attend school in the United States of America?    
Have you ever been convicted or do you have a conviction pending of a crime?    
Existence of convictions will not necessarily disqualify an applicant from volunteering. The term crime includes felonies and/or misdemeanors but does not include minor traffic infractions. It does include crimes such as driving under the influence, leaving the scene of an accident, driving with a suspended license or reckless driving.
 
If you answered YES to the above question, please explain the conviction in detail in the box below:  
What positions are you interested in pursuing? Check your top three choices. Click the job title for a description of duties. Chaplain Assistant
Clerical Assistant
Community Outreach Assistant
Escort
Eucharistic Minister
Family Liaison
Gift Shop Clerk
Music Practitioner
Patient Care Assistant
Pet Partner
Pharmacy Clerk
Receptionist
Please answer these questions regarding your skills or talents that you would be willing to share with us.
Are you comfortable answering a telephone and making calls?    
Do you have clerical skills (i.e. filing, copying, etc.)?    
Are you proficient with WORD software?    
Are you proficient with EXCEL software?    
Are you proficient with PowerPoint software?    
Are you proficient with Publisher?    
Do you have any current certifications?  
If yes, what certification?
Expiration Date?


Do you crochet, knit or sew?    
Do you have a musical talent?    
If you answered YES to the above question, please list the instrument(s) you play:  
Are you skilled at using a digital camera or videotaping?    
What language(s) are you fluent in?  
What other skills or talents would you like to share with us?  
Please indicate the days and times you would be available to volunteer:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
 
By typing my name here, I understand and agree that submitting this application does not automatically authorize me to volunteer. I understand that I must meet the criteria set forth by Franciscan Health System. I also understand that my acceptance into the volunteer program is contingent upon the receipt of a satisfactory background report as determined by Franciscan Health System.
  *
 
By typing my name here, I understand and agree that my services are given with humanitarian or charitable reasons and are donated to Franciscan Health System without expectation of any compensation, salary, benefits, other payment or future employment. I understand that as a volunteer, I am not covered by any state or federal wage or hour laws, nor am I eligible for workers’ compensation, unemployment insurance benefits or any other benefit available to employees.
  *
 
By typing my name here, I certify that the information set forth in this application is true and complete to the best of my knowledge. I understand that falsified statements on this application or failure to furnish all requested information shall be considered sufficient cause for my dismissal from the volunteer program.
  *