OSF Volunteer Services / Volunteer Application

Volunteer Services
Volunteer Application
(309) 655-2118

Volunteer Services Application Form

Personal Information:
Name (first, middle initial, last)
Date of birth
Home Phone (with area code)
Cell Phone (with area code)
Street address
City
State
Zip
Email Address
In case of emergency, contact:
Name
Phone (with area code)
Work History:
Are you employed? Yes No	Are you retired Yes No
If yes for employed, where?
How long have you been there?
Name and phone number of a person we can contact at that place of employment?
Education:
High school name
High school: Currently attending > Graduate > Did not graduate >
College name
College: Currently attending > Graduate > Did not graduate >
Other Information:
Have you ever pled guilty to or been convicted of any criminal offense other than minor traffic violations?	Yes No
If yes please explain.
Please List 3 references that are non-family members:
Name
Address
Phone

Name
Address
Phone

Name
Address
Phone

Opportunities that interest you:
Ambulatory Surgery	Angiography
Cardiology	Children's Hospital
Clerical	Clinics
Emergency Department	Flowers and Mail
Greeter	Hospitality/Host
Information Desk	Nursing Areas/Ambassador
Parking Services	Patient Advocate
Patient Library	Pediatrics
Physical Therapy	Transportation
Waiting Room Attendant	Outpatient Facilities

Preferred Days:	Preferred hours:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Best time of day to contact you AM PM
Feel free to add any additional comments or explanations.

Please click once to submit application