Volunteer Application

EXPERIENCE, SKILLS & INTERESTS (Tell us about yourself!)

  How did you become interested in volunteering with PHLB?

  Please list previous volunteer experience, organizations, professional societies or any other relevant information.

  Are you volunteering to earn hours for a school or education program?

 Yes – If yes, please describe: 
 No

  Do you read, speak or write a language other than English?

 Yes – If yes, list languages: 
 No

If yes, would you be interested in interpreting for patients/visitors?   Yes    No

  Do you have any physical limitations or medical conditions you may have that would prevent you from performing certain types of work?

 Yes – If yes, please list: 
 No

There are job criteria and physical requirements for each position.
We will try our best to assign you to a position that will accommodate your skills or limitations while mutually benefiting you as well as the hospital.

  In what areas are you most interested in volunteering?

  Please indicate your preference of hours for volunteering.

 8:00a to 12:30p:  Mon  Tues  Wed  Thurs  Fri  Sat  Sun
12:30 p to 4:30p:  Mon  Tues  Wed  Thurs  Fri  Sat  Sun

  May we contact you to assist with special projects such as Health Fairs?

 Yes      No

THREE REFERENCES (Please do not list relatives)

AGREEMENT

• I understand any misrepresentation or material omission of information in this application may be a cause of dismissal from the Volunteer Services of Pacific Hospital of Long Beach.
• I understand that there are job criteria for positions. We will try our best to accommodate your skills, limitations, etc. to assign you to an available position that will be mutually beneficial to you and Volunteer Services of Pacific Hospital of Long Beach.
• I understand that state & national hospital regulatory agencies require that persons working in a hospital setting receive orientation/training each year and have an annual TB test. Failure to do so may results in temporary suspension from the Volunteer Services until completed.
• I agree to read & abide by the policies and procedures, expectations, ethics, customer service standards as presented in the “Volunteer Handbook” and orientation and to perform the duties expected of me to the best of my ability.

CERTIFICATION (Must be completed in order to submit application!)

 I hereby certify that all the information included on this application is true and complete to the best of my knowledge.