Volunteer Application

Volunteer Application

If you're interested in helping people, volunteering with the Memorial Hospital Auxiliary is a great way to do that.

Applicant Information

Please Note: A conviction record will not necessarily be a bar to volunteerism. Factors such as age and time of offense, seriousness and nature of the violation, and rehabilitation will be taken into account.

Volunteer Experience

Community Involvement

Please list your involvement with community organizations.

Emergency Contact Information

Work Experience

Please provide information about your current employment and/or former work history.

Education & Skills


Please list the complete mailing addresses for two references. A form will be mailed to each reference prior to your invitation to an orientation session. References can be business/job related, personal, etc. but cannot be a family member.

Please read the following statement and sign the application.

The information provided on this application is true and complete. I understand that any false or misleading representations or omissions will disqualify me for future consideration of volunteer opportunities. I agree to abide by Memorial Hospital and Memorial Hospital Auxiliary rules, policies and procedures including safety and infection control training and practices, service standards, identification badges, confidentiality policies, dress code requirements and time recording procedures. I furthermore understand that any offer of a volunteer service position is contingent upon the satisfactory completion of the required physical and a signed authorization for a complete criminal background check.

I acknowledge that my volunteer services are provided to Memorial:

  • on a voluntary basis for humanitarian reasons;
  • with no expectation of compensation or wages;
  • with no expectation of any benefit(s), including workers’ compensation;
  • for the aid and comfort of patients;
  • freely without pressure or coercion;
  • with no economic dependence upon Memorial or its affiliates;
  • solely for personal purpose or pleasure.

By submitting this Application, I the undersigned acknowledges that Memorial will periodically verify my background and whether I remain eligible to provide volunteer services at Memorial as required by law.

C915-005 Revised 05/13