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Volunteer Application
Volunteer Application
Contact Information
Last Name*:
First Name*:
Address 1*:
Address 2:
City*:
State:
Zip*:
Home Phone*:
Cell Phone:
Email*:
Birth Date*:
Marital Status:
Single
Married
Divorced
Widowed
Education (Select last year finished)
High School:
1
2
3
4
College:
0
1
2
3
4+
Emergency Contacts
Name:
Relationship:
Home Phone:
Alt. Phone
Name:
Relationship:
Home Phone:
Alt. Phone:
Employment Status
Currently Employed?
Yes
No
Current or last place of employment:
Volunteering Availability
(Please select all that apply)
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Morning
Afternoon
Evening
Morning
Afternoon
Evening
Morning
Afternoon
Evening
Morning
Afternoon
Evening
Morning
Afternoon
Evening
Morning
Afternoon
Evening
Morning
Afternoon
Evening
Morning:
8 am to 12 pm
Afternoon:
12 pm to 4 pm
Evening:
4 pm to 8 pm
Personal References
(Not a relative please)
Name:
Phone:
Relationship:
Name:
Phone:
Relationship:
Background Information
Have you ever been convicted of a crime?
No
Yes
Do you have a valid drivers license?
Yes
No
What do you like to do?*
Will you need time off from volunteering?*
Have you ever volunteered before?
Yes
No
Doing what?
What did you enjoy most about volunteering?*
What did you like least about volunteering?*
Do you like to work on your own or with a partner and why?*
Why did you pick Central DuPage Hospital?*
Why did you pick now to volunteer?*
List one of your greatest accomplishments?*
What do you hope to gain from this experience?*
What do you see yourself doing as a volunteer at Central DuPage Hospital?*
Is there anything you would like to tell me about yourself that would help me find the best volunteer position for you?
(physical limitations, medications, etc)*
Are you flexible about the kind of volunteer work you do?*
Are you interested in working with:
Patient or Public Contact
Clerical or No Public Contact
No Preference
Please only click on the Submit button one time.
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Central DuPage Hospital | 25 North Winfield Road | Winfield, IL 60190 | 630-933-1600 | TTY for the hearing impaired 630-933-4833
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