John Muir Health Volunteer Application Form

Thank you for your interest in volunteering with John Muir Health. In order to submit a volunteer applicaton, please start by creating an account.

Your account password must contain at least one capital letter, one lower case letter, one number and be at least 8 characters long.

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User ID

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Password

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John Muir Health
Application for Volunteer Services (Applicant must be 18+ years old)

Requested location

Are you currently a college student

PERSONAL INFORMATION

* First name

* Family/last name

* Street Address

* City

State

* Zip/postal

* County

* E-mail

* Phone (Home)

Phone (Cell)

Phone (Business)

* Date of Birth

IN EMERGENCY WE SHOULD NOTIFY

* Contact name

* Relationship

* Home phone

Work phone

Mobile

CURRENT EMPLOYMENT (if applicable)

Company

May we call you at work?

Street Address

Position

City

Work phone

Hours

SCHOOL (if applicable)

Are you currently enrolled in school?

If yes, where?

Major?

PRIOR EXPERIENCE

Volunteer

Education & Special Training

Are you a Registered Nurse?

Physician (MD or DO)?

Certified Nursing Assistant (CNA)?

Other healthcare professional/allied health care worker?

REASONS FOR VOLUNTEERING

* Please share with us why you would like to volunteer at John Muir Health?

Are you interested in volunteering to fulfill court appointed community service hours?

* Please type your name as you would like it to appear on your Photo ID Badge:

How did you hear about us?

PLEASE CHECK WHICH AREAS APPLY TO YOUR INTERESTS

PATIENT contact services

NON-PATIENT contact services

UCSF-JMH Jean and Ken Hofmann Cancer Center

Courtesy Shuttle Driver

Gift Shop

Lay Eucharistic Minister

Musician

Student Supervisor (Walnut Creek only)

Do you have a specific area or service in mind?

CHECK THOSE THINGS IN WHICH YOU ARE EXPERIENCED AND/OR INTERESTED

Clerical/other duties

Hosting/Registration

Knitting/Sewing

OTHER INFORMATION

List limitations related to health (physical and/or mental):

(Limitations will not necessarily disqualify you from volunteering)

Are you a relative of an employee? Who?

Do you speak a language other than English?

Language

Ethnicity

Opportunities for volunteers are provided without regard to religion, creed, race, national orgin, age or sex,

The above information is accurate and correct to the best of my knowledge.

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John Muir HealthApplication for Volunteer Services (Applicant must be 18+ years old)

Application for Volunteer Services (Applicant must be 18+ years old)

PERSONAL INFORMATION

IN EMERGENCY WE SHOULD NOTIFY

CURRENT EMPLOYMENT (if applicable)

SCHOOL (if applicable)

PRIOR EXPERIENCE

REASONS FOR VOLUNTEERING

PLEASE CHECK WHICH AREAS APPLY TO YOUR INTERESTS

CHECK THOSE THINGS IN WHICH YOU ARE EXPERIENCED AND/OR INTERESTED

OTHER INFORMATION

John Muir Health
Application for Volunteer Services (Applicant must be 18+ years old)