Adult Volunteer Application

To be considered for a volunteer position at Morristown Memorial Hospital, please fill out this form and submit it. Thank you for your interest in volunteering at Morristown Memorial Hospital.

Prospective Volunteer

Last Name:

First Name:

Address:

Birthdate:

Contact Information

Home Phone:

Work Phone:

Cell Phone:

Preferred Email:

May we contact you at work?

Yes No

Emergency Contact Information

Name:

Phone:

Relationship:

Employment Information

Employer:

Address:

Are you a current or former employee of any health care facility affiliated with Atlantic Health?

Yes No

Education

High School:

College:

Degree:

Other Education:

Criminal History

Have you ever been convicted or plead guilty to a crime or criminal offense, other than a minor traffic violation, which has not been expunged or sealed by a court?

Yes No

If yes, please explain:

Availability

Please indicate when you are available for a volunteer assignment.

	Mon	Tues	Wed	Thur	Fri	Sat	Sun
Morning
Afternoon
Evening

Please list your top three positions or areas for volunteering:

References

We check references through a mailed form. Please provide the full mailing address and zip code of your references; please do not use relatives for references.

Reference 1

Reference 2

Applicant Authorization

I understand that completion of this application and/or interview/screening process are not a promise of an offer of assignment. As a volunteer, I have no expectation of compensation for services provided. If I have provided false or misleading information, I acknowledge that Atlantic Health may terminate any volunteer assignment immediately.

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