Volunteer Application

Thank you for your interest in becoming a volunteer at Premier Health. Once all forms have been received, we will contact you to schedule an interview/orientation to discuss volunteer openings, safety guidelines within the hospital, and days and times you would like to volunteer.

1 General Volunteer Application
2 Documents
3 Certify and Submit

What hospital location do you want to volunteer at?

Contact Information

Name (First)

(Last)

(Middle Initial) (optional)

Address Line 1

Address Line 2 (optional)

City

State

ZIP code

Date of birth: (mm/dd/yyyy)

Home phone

Cell phone (optional)

Employment History

Name of current or last employer

Address Line 1

Address Line 2 (optional)

State

ZIP code

How long?

Retired (optional)

Phone

Occupation

Previous Volunteer Experience

Organization name

How long did you volunteer?

Supervisor Name

Supervisor Phone Number (optional)

Organization name

How long did you volunteer?

Supervisor Name

Supervisor Phone Number (optional)

Emergency Contact

Name

Relationship

Address Line 1

Address Line 2 (optional)

State

ZIP code

Home phone

Cell phone (optional)

Your physician

Physician Phone number

Personal Interests etc.

Please list any information that is pertinent to your application, including interests, hobbies (sitting, answering phones, moving about, paperwork, being with people)

Why do you want to volunteer?

Why would you be a good volunteer?

Do you have any medical concerns that could physically, emotionally, or mentally limit your health? (optional)