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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 four month commitment
4. Purchase the approved volunteer uniform ($23-41, 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:
A A?? Review the health assessment forms
A A?? Review copy of immunizations
A A?? Receive a mandatory tuberculin skin test which requires a small blood sample - at no charge
A A?? 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

Emergency Contact

Volunteer Interest
If none please type "NONE" in the box.

***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)*
Have you ever been convicted of a felony or have charges pending? (This would include traffic violations)*
(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.
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.