Giving

We appreciate you.
Giving

HealthEast Volunteer Application

Thank you for your interest in volunteering at HealthEast. Volunteers play an integral part in our success. Your dedication enhances the care we provide to our patients.

To apply for a volunteer position, please complete the form below. Once you have submitted this form, you will be taken to a page with a recommendation form that is required for your application to be complete. Your application will not be considered until this form is returned to HealthEast.

*Indicates required field

I would like to volunteer at:*
Please choose a location.

Age*
Indicate your age range.

First name*
Enter your first name.

Middle initial
Invalid Input

Last name*
Enter your last name.

Date of birth*
/ / Invalid Input
Street address*
Enter your street address.

City*
Enter your city.

State*
Select your state.

Zip Code*
Enter your zip code.

E-mail address*
Enter a valid e-mail address.

Confirm e-mail address*
Enter a valid e-mail address.

Home phone*
Enter 10-digit home phone number.

xxx-xxx-xxxx

Cell phone
Enter 10-digit phone cell number.

xxx-xxx-xxxx

Emergency contact

If you are under 18, please list your parent or guardian as your emergency contact.

Name (first and last)*
Enter the name of your emergency contact.

Relationship*
Enter your relationship with your emergency contact.

Home phone*
Enter 10-digit phone number.

xxx-xxx-xxxx

Work phone
Enter 10-digit phone number.

xxx-xxx-xxxx

Cell phone
Enter 10-digit phone number.

xxx-xxx-xxxx

Please list a second emergency contact in case your parent or guardian is unavailable.

Name
Enter the name of your emergency contact.

Relationship
Enter your relationship with your emergency contact.

Phone number
Enter phone number.

Alternate phone number
Invalid Input

Employment

Are you currently employed?*
Indicate current student status.

Current employer
Enter your current or most recent employer.

Education

Are you currently a student?*
Indicate if you are a student.

School currently attending
Enter the school you are currently attending.

Graduation date (actual or anticipated)
Enter your graduation date.

Most recent school attended
Enter the school you last attended.

Volunteer information

Why are you interested in volunteering for us?*
Why are you interested?

How did you learn of our volunteer program?*
Enter question answer.

Please list any prior volunteer experience.*
Enter prior experience.

What types of things do you like to do in your leisure time?*
Enter leisure activities.

Please list school, church, or community activities and/or clubs you belong to:*
Enter your activities.



Type of volunteer work preferred (varies by site):

Choose a type of work.


Type of volunteer work preferred (varies by site):*

Choose the type of work.

Type of volunteer work preferred (varies by site):*

Choose a type of work.

Type of volunteer work preferred (varies by site):*

Choose the type of work.


Please list any health precautions/ restrictions such as lifting, pushing wheelchairs, etc.
Enter information.

Availability

Volunteers typically donate one four-hour shift per week, scheduled according to department need and volunteer availability. Volunteers are asked to make a minimum commitment of one shift per week for six months.

Which session(s) are you applying for?*

Indicate when you want to volunteer.

Availability

  Sun. Mon. Tue. Wed. Thu. Fri. Sat.
Morning
Afternoon
Evening
Select your preferred volunteer times.

Availability during the school year

  Sun. Mon. Tue. Wed. Thu. Fri. Sat.
Morning          
Afternoon
Evening
After school    
Select your preferred volunteer times.

Which, if any, months are you unavailable?
Enter the months.


Confidentiality statement

I recognize that as a volunteer, I will come to know confidential information found in a hospital setting. I will not disclose or discuss such privileged information with anyone. I will not reveal names of patients nor visit a patient I know, unless that information has come to me outside of hospital records. Any specific patient and physical medical information will not be discussed during breaks, lunch or in any public area of the hospital or outside of the hospital. I understand that any breach of confidentiality will result in termination of my volunteer position.

I give my permission for HealthEast to complete a State of Minnesota background study form.

I have read and understood the statement above. Selecting "yes" below indicates my agreement as well as my permission for HealthEast to complete the background study.

Invalid Input

HealthEast Volunteer Services is not obligated to provide placement, nor are you obligated to accept the position offered.

Completing your application

Please note, once you have submitted this form, you will be taken to a page with a recommendation form that is required for your application to be complete. Your application will not be considered until this form is returned to HealthEast.