Volunteer Application | WVU Healthcare

Volunteer Status
Volunteer Status:	Junior Volunteer - 14 - 18, attending high school. Accepted only for Summer. The next enrollment period is Monday, April 2, 2012—Friday, May 4, 2012. Student Volunteer - 18+ attending a college/university. Next enrollment period is Monday, April 2, 2012—Friday, May 4, 2012. Adult Volunteer - 18+ not attending a college/university. Applications accepted anytime.
Name
First Name:
Middle Name:
Last Name:
Contact Information
E-mail:
Telephone:	() -Second partThird part
Phone Ext.:
Current Address
Street Address:
Apartment/Address 2:
City:
State:
Zip Code:
Permanent Address
Street Address:
Apartment/Address 2:
City:
State:
Zip Code:
Emergency Contact Information
Name:
Relationship:
Phone:	() -Second partThird part
Felony
Have you ever been convicted of a crime or are you under charges for any offense against the law other than minor traffic violations?:	Yes No
If yes, give details:
Experience
Prior experience as a volunteer:
How did you become interested in our hospital volunteer program?:
References
References:	Please list two professional references along with complete addresses. Examples: employers, teachers, co-workers, ministers, etc. If you are a Junior Volunteer, you will need to bring two written letters of recommendation to your interview. Letters can be from teachers, coaches, ministers, someone from whom you've babysat, etc. NO RELATIVES PLEASE!
Reference 1
Name:
Title:
Phone:	() -Second partThird part
Street Address:
Apartment/Address 2:
City:
State:
Zip Code:
Reference 2
Name:
Title:
Phone:	() -Second partThird part
Street Address:
Apartment/Address 2:
City:
State:
Zip Code:
Your Service Preferences
Please select three options. Due to high demand, some positions are not available on a regular basis:	Working with children (must be 18+) Working with patients & families Clerical/Office resource Gift Shop Pharmacy (Pre-pharmacy students only) Rehabilitation Services (Pre-Physical & Occupational Therapy students only) Morgue & Anatomic Pathology Any available position
Other Service Request:

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Application For Volunteering