Volunteer Application

Name:

Email:

Telephone:

Address 1:

Address 2:

City:

State:

Zip:

Person to contact in case of emergency:

Contact person's phone number:

Have you ever worked or volunteered for this organization before?:

Yes

No

Education / Special Training:

Work Experience:

Please explain how you heard about our volunteer program:

Please indicate in what areas you would like to volunteer:

Atrium Host

Surgery Host

Gift Shop

Coffee Shop

Mail & Flower Delivery

Please check mark the days which you are available to volunteer:

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Hours vary in each area. Please contact the volunteer office at (515) 433-8139 and leave a message. A volunteer will return your call with the hours.:

Reference Name 1:

Reference Address 1:

Reference City 1:

Reference State 1:

Reference Zip 1:

Reference Email Address 1:

Reference Phone Number 1:

Reference 1 Relationship to You:

Reference Name 2:

Reference Address 2:

Reference City 2:

Reference State 2:

Reference Zip 2:

Reference Email Address 2:

Reference Phone Number 2:

Reference Relationship to You 2:

Volunteer Application

Boone County Hospital Volunteer Application