Submit your Volunteer Application Today!

Contact Information
First Name (required)

Middle Name

Last Name (required)

Address (required)

City (required)

State (required)

Zipcode (required)

Phone (required)

Your E-mail (required)

Birth Date (required)

SS#

Gender (required)
MaleFemale

Emergency Contact Information
Emergency Contact Name (required)

Emergency Contact Phone (required)

Relationship (required)

Experience/Work History/Background
Are you presently Employed? (Check all that apply)
YesNoFull TimePart Time
Past or current ORHC Employee?
YesNo

Most Recent Employer

Date Range of Employment

Job Responsibilities

References
List two persons not related to you, who can judge your qualifications for this position. If you have previous experience as a volunteer, one reference should be from that organization. Please include COMPLETE addresses and phone numbers.
Reference Name (required)

Address (required)

City (required)

State (required)

Zipcode (required)

Phone (required)

E-mail (required)

Relationship (required)

Volunteering/Availability
Volunteer Service Area Preference (Check all that apply)
Osceola Regional Health Center (Hospital Greeter): Welcomes patients and visitors upon their arrival to the hospital and help direct or escort them to their destination.Heartwood Heights: Assist with activities, provide one on one visitation to residents and assist staff on various outings.New Beginnings Thrift Store: Sort donated items, price and display merchandise.

Desired number of hours per week (required)

Desired number of days per week (required)

Availability (Check all that apply)
MondayTuesdayWednesdayThursdayFridaySaturdaySunday

Hours Preferred (Check all that apply)
MorningsAfternoonsEvenings

I understand and will comply with all of the following if accepted as a volunteer:
■ I voluntarily offer my services with a clear understanding that there is no monetary compensation
■ I will endeavor to be prompt and regular in my service.
■ I will observe all hospital regulations.
■ I authorize persons listed as references to release information.
■ I understand that Osceola Regional Health Center may complete a criminal background check.
■ I certify that all information on this application is true and complete.

Digital Signature (required)

Today's Date (required)

Δ