Welcome to Stormont-Vail Volunteer Services

Adult Volunteer Application Form

Please complete ALL fields before clicking the button to submit.
ADULT Volunteer Eligibility Requirements
Application and Eligibility Requirements
These requirements are provided at no cost to the volunteer except for #4

1. Minimum age 18
2. Physically, mentally and emotionally able to perform duties assigned
3. A minimum six month commitment (except summer program)
4. Purchase the approved volunteer uniform ($20-28, depending on selection)
5. Complete application
6. Attend an interview with a Volunteer Services representative
7. Upon acceptance, you will need to provide reference and background check processing information. You will also meet with the hospital's employee health nurse to:
· Review the health assessment forms
· Review copy of immunizations
· Receive a mandatory tuberculin skin test which requires a small blood sample - at no charge
· Receive flu vaccination (Sept. - May)
8. Complete new volunteer orientation prior to the 1st day of volunteering.
ADULT Volunteer Application
***If a field is not applicable please type N/A in the box.

Personal Information
First name*
Middle name*
Last name*
Preferred first name*
Date of Birth*
Gender*
Home Address*
E-mail*
City*
State*
Zip/postal*
Cell phone*
Home phone*
Work phone*
Best contact phone*

Emergency Contact
Name*
Relationship*
Address*
City*
State*
Zip*
Work phone*
Cell Phone*
Home phone*
Best contact phone*

Volunteer Interest
Have you ever been a Stormont Vail Volunteer?*
Indicate the reason you are seeking a volunteer position.*
What minimum commitment can you make?*
If none please type "NONE" in the box.
Please explain any conditions or limitations which may affect your ability to volunteer.*

Are you legally eligible to reside in the United States?*
***Please note we do not accept applicants seeking court mandated community service hours.
Have you ever been convicted of a misdemeanor or have charges pending? (This would include traffic violations)*
If yes, please explain.
Have you ever been convicted of a felony or have charges pending? (This would include traffic violations)*
If yes, please explain.*
(Stormont Vail Health conducts criminal record checks. Failure to divulge complete information may disqualify you from volunteer service. However, a conviction will not necessarily disqualify an applicant from applying).

My typed name below shall have the same force and effect as my written signature.
Yes, I agree to these terms*
To digitally sign this message type your full legal name in UPPERCASE:*
Date*
Upon submission of your application you will be contacted by the volunteer office within two to three business days. If you have questions please contact us at volunteerdept@stormontvail.org or (785) 354-6095.