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Adult Volunteer Application
Adult Volunteer Application
*
Required Info
First Name:
Last Name:
Address:
City:
State:
ZIP:
Phone:
Email:
Areas of Interest: Please check all that apply:
Information Desk
Greeter
Chemo Buddies
Clerical
Critical Care Waiting
Mahr Center
Emergency Dept
Outpatient Registration
Other (Detail Below)
If you selected "other" above, please detail your interest in this field:
Last Year of School Completed:
Select
HS - Freshman
HS - Sophomore
HS - Junior
HS - Senior
HS - GED
College - Year 1
College - Year 2
College - Year 3
College - Year 4
Name of school most recently attended:
Work Experience:
Have you ever been convicted of a crime, other than minor traffic violations?
Yes
No
Note: Answering "yes" does not necessarily disqualify you from volunteering
Skills, abilities and special training:
Previous volunteer experience:
What is your availability?
Days of the week available:
Hours available:
How did you hear about our volunteer program? :
What influenced you to volunteer?:
List the names and numbers of two personal references that are not kin:
Name:
Phone:
Name:
Phone:
I authorize Baptist Health Deaconess Madisonville to request information concerning my character and reliability from the above named references.
Signature:
Adult Volunteer Application
Youth Volunteer Application (PDF)
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