Teen Volunteer Application | Catholic Medical Center

You must be willing and able to volunteer a minimum of eight (8) hours each month for at least six (6) consecutive months, preferably longer if possible. You and your supervisor will discuss and set up a schedule that is mutually agreed upon by both parties. When you are unable to make it in for your scheduled volunteer shift, you must notify your immediate supervisor or someone in the department where you serve (not the Volunteer Department). I certify that all the information that I provide on this volunteer application and in any interview will be complete, true and accurate. I understand that if any such information is later found to be incomplete, false or misleading in any way it may be considered sufficient cause for termination of my volunteer service. I agree that Catholic Medical Center and any of the references provided on this application, may exchange information regarding my qualifications without incurring any liability whatsoever for supplying such information. I understand that I will not be paid for my services as a volunteer. I agree to abide by all organization and volunteer policies. I understand that CMC is not obligated to provide volunteer placement, nor am I obligated to accept the volunteer assignment offered.

Please note: Volunteer placement is subject to:

Satisfactory medical history review and required testing.
Personal interview with the Volunteer Services, and/or department staff as required.
Willingness to abide by all hospital requirements and regulations.
Youth Employment Certificate (if applicable)
My typed name below shall have the same force and effect as my written signature.

My typed name below shall have the same force and effect as my written signature.

Signature of Applicant:

Qualified applicants shall receive consideration regardless of race, religion, color, creed, national origin, sexual orientation, age, disability, marital status or any other legally protected status.

Last Name:

First Name:

Middle Name:

Preferred Nickname:

Date of Birth:

Home Street Address:

Apartment Number:

City:

State

ZIP:

Email:

Cell Phone:

Parent or Legal Guardian:

I am

Employed Full Time Employed Part Time Student

School name:

Grade:

Career or college major interest:

Current employer:

Current job position:

What days do you work:

What hours do you work:

Previous work or volunteer experience:

Extracurricular activities:

Reasons you’d like to become a CMC volunteer

Interest in a healthcare career To gain work experience For my college application

Additional reasons:

How did you learn about our teen volunteer program?

Guidance Counselor I called the CMC Volunteer Dept I was referred by someone CMC newsletter

Name of the person who referred you:

Please answer each question thoroughly; this section plays a key part in the selection of our Teen Volunteer Program participants.

What inspires you to become involved in the Volunteer Program?:

What would you like to gain from your volunteer experience at CMC?:

What skills and experience would you like to share in your role as a volunteer:

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