Bonner General Health Volunteer Application

Bonner General Health Volunteer Application
Name

Legal Name (last, first, initial)Date
Preferred Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Secondary Phone
Please enter a valid phone number.
Birthdate

MonthDayYear
Date
Under 18?

YesNo
Emergency Contact Information
Emergency Contact Person

Name Relationship
Emergency Contact Phone Number
Please enter a valid phone number.
Previous Work History
Previous Volunteering
Education or Special Training
Any Additional Comments or Information
I am interested in volunteering at:*

Volunteer Council (volunteer at the BGH campus)Bonner General Communiity HospiceThe Healing GardenFundraisers & Events
Your Volunteer Preferences
Your skills and talents

ComputerMusicBakingFiling/ ClericalMechanicsMending/ SewingPublic RelationsWoodworkingRetailEvent Planning
Volunteer Service Areas -check all that interest you

MaintenanceMedical/ Surgical FloorHospitalitySurgery - Post OpCancer CenterCafeteriaLobby DeskSame Day Surgery DeskBusiness ServicesPharmacyOsteoporosis ClinicEmergency DepartmentLaundry/ MaterialsOutside Work (yard & grounds)
Type of service you prefer

Patient CareClericalVisitor PR & AssistanceSpecial Interest
Days Preferred

MondayTuesdayWednesdayThursdayFridaySaturday
Hours Preferred

MorningAfternoon
Have you ever been convicted of a felony/misdemeanor? If yes, please explain
How did you learn about the BGH Volunteer Program?
Why do you want to volunteer for Bonner General Health
Example: college requirements, community service obligation, would like to give back to the community, etc.
How much time would you be willing to volunteer each week?

Four HoursThree HoursOther
Would you be able to make a 3 month volunteer commitment?
References

(Adults may list personal or professional references. Teens may list a school counselor, teacher or pastor.)
Reference #1

First & Last Name Phone Number
Reference #2

First & Last Name Phone Number
Do we have permission to contact the references above?

YesNo
Signature

Clear
Should be Empty:

Bonner General Health Volunteer Application

Emergency Contact Information

Previous Work History

Your Volunteer Preferences

References