Personal Information
Your Name *
Email *
Phone *
Cell *
Your Address *
City*
Postal Code*
Gender (Optional)
Best time and method to reach you *
Current Status * High SchoolUniversity/CollegeF/T EmployedRetired
Emergency Contact*
Emergency Contact Phone *
Relationship*
In order to provide you with a positive Volunteer Experience, are there any special considerations that would be helpful for us to know about you (e.g. Health Concerns, physical restrictions)?
How did you hear of this volunteer opportunity? *
Please indicate which area of volunteer involvement interests you: *
Patient Services (face-to-face opportunities)Administrative ServicesFundraising/Financial ServicesOther
Weekly ShiftOn CallOne Time/Special Event
Monday:
MorningAfternoonEvening
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Availability information and any restrictions that may be of note:
Previous work/volunteer experience: *
Special skills and experiences including fluency in languages other than English:
You will be provided with a form that must be completed by 2 references. References can be of a personal and/or professional nature. The references you choose may not be a family member.
Your participation with Norfolk General Hospital/Norfolk Hospital Nursing Home will proceed when screening and training have been completed.
Norfolk General Hospital/Norfolk Hospital Nursing Home collects your personal information in order to help identify suitable volunteer opportunities for you. Only authorized staff and/or volunteers access this information. Please be advised that we cannot always place a volunteer in a volunteer position.
All adult (18+) applicants must provide a Police Reference Check with Vulnerable Sector Query prior to placement.
By submitting this application form, you are authorizing Norfolk General Hospital/Norfolk Hospital Nursing Home to use the content for the purpose of processing this application.
I understand and agree with the terms of this application YesNo
