volunteer hospital application

(* denotes required information)

Personal Information

Name *
Street Address *
City *

Zip Code *
Phone Number *
Email Address *
Birthdate *

Occupation Information

Present Occupation
Employer
Phone Number
Education and Training

Volunteering History

Volunteer Experience

If yes, please describe

Contact for Medical Clearance

Your Physician's Name *
Street Address *
City *
Zip Code *

Personal History


If yes, please describe

If yes, please describe

Personal Interests

Hobbies, special interests, organizations (church, civic, etc.)

Personal Reference #1 (other than family)

Name *
Street *
City *

Zip Code *
Phone Number *

Personal Reference #2 (other than family)

Name *
Street Address *
City *

Zip Code *
Phone Number *

Availability to Volunteer

Days available 
(check all that apply)

 Sunday
 Monday
 Tuesday
 Wednesday
 Thursday
 Friday
 Saturday

Times available

 morning
 afternoon
 evening
 weekly
 biweekly
 monthly

Desire to Volunteer

Why do you wish to volunteer at St. Francis?

If yes, where

Emergency Notification

Notify in case of emergency:

Name *
Relationship to You *
Street Address *
City *
Zip Code *

Home Phone *
Business Phone *

I certify that answers given here are true and complete to the best of my knowledge.

I hereby give St. Francis permission to contact the listed references, physician, and to conduct a drug screening or criminal check if appropriate.

A health assessment and safety training are required by the hospital. I understand that volunteer placement is contingent upon completing all initial and future health requirements and training as required by Bon Secours St. Francis Health System.

 I agree with the above statements. *
* required fields
Bon Secours International| Sisters of Bon Secours USA| Bon Secours Health System