Get Helen Hayes Hospital Volunteer Services Application Form 2008-2024

Volunteer Services Application Form VOLUNTEER CORPS Date Preferred Nickname Last Name First Name Home Address City State Phone Home M. I. Apt Phone Work I prefer to receive calls at Date of Birth Home Business Either Zip Code E-mail address Social Security Driver s License Number In Case of Emergency Notify Relationship Employment Information Unemployment Phone Employed Occupation Student Employer s Name or School Retired Have you ever volunteered in a hospital before No Educational Background Yes If yes where and in what capacity What type of volunteer work are you interested in What skills or special talents would you like to share in volunteering How did you find out about our Volunteer Program Why do you want to volunteer Except for adjudications as a youthful offender wayward minor or juvenile delinquent have you ever been found guilty of ANY misdemeanor felony or forfeited bail in any court No Yes If yes give details on back side of this sheet. Volunteer Services Application Form VOLUNTEER CORPS Date Preferred Nickname Last Name First Name Home Address City State Phone Home M. I. Apt Phone Work I prefer to receive calls at Date of Birth Home Business Either Zip Code E-mail address Social Security Driver s License Number In Case of Emergency Notify Relationship Employment Information Unemployment Phone Employed Occupation Student Employer s Name or School Retired Have you ever volunteered in a hospital before No Educational Background Yes If yes where and in what capacity What type of volunteer work are you interested in What skills or special talents would you like to share in volunteering How did you find out about our Volunteer Program Why do you want to volunteer Except for adjudications as a youthful offender wayward minor or juvenile delinquent have you ever been found guilty of ANY misdemeanor felony or forfeited bail in any court No Yes If yes give details on back side of this sheet. Have you ever been involved in an abuse mistreatment and/or neglect investigation by any facility or state agency e*g* Dept of Health Child Abuse Registry Dept of Social Services I hereby affirm that this application contains no willful misrepresentations or falsifications and that this information given by me is true and complete to the best of my knowledge and belief* I am aware that should investigation at any time disclose any misrepresentation or falsification my application will be disapproved and my appointment may be rescinded* I am also aware that a false statement is punishable under law by fine or imprisonment or both. I. Apt Phone Work I prefer to receive calls at Date of Birth Home Business Either Zip Code E-mail address Social Security Driver s License Number In Case of Emergency Notify Relationship Employment Information Unemployment Phone Employed Occupation Student Employer s Name or School Retired Have you ever volunteered in a hospital before No Educational Background Yes If yes where and in what capacity What type of volunteer work are you interested in What skills or special talents would you like to share in volunteering How did you find out about our Volunteer Program Why do you want to volunteer Except for adjudications as a youthful offender wayward minor or juvenile delinquent have you ever been found guilty of ANY misdemeanor felony or forfeited bail in any court No Yes If yes give details on back side of this sheet. Have you ever been involved in an abuse mistreatment and/or neglect investigation by any facility or state agency e*g* Dept of Health Child Abuse Registry Dept of Social Services I hereby affirm that this application contains no willful misrepresentations or falsifications and that this information given by me is true and complete to the best of my knowledge and belief* I am aware that should investigation at any time disclose any misrepresentation or falsification my application will be disapproved and my appointment may be rescinded* I am also aware that a false statement is punishable under law by fine or imprisonment or both. .