Welcome to St. Peter's Health Partners - Acute Care!

Home

Please complete all applicable questions on the application form. Incomplete forms will delay the processing of your application.

New User Details

User ID

User ID (verify)

Password

Password (verify)

Personal Information

* First Name

* Last Name

* DOB (MM/DD/YYYY)

Gender

* Street Address

Unit

* City

* State

* Zip Code

* Primary Phone

Secondary Phone

* E-mail Address

Current Status and Experience

Current Status

Are you a current or former employee of UnityPoint Health - Meriter?

If yes, which department and when?

Do you have experience in a healthcare setting?

If yes, please describe briefly:

Areas of Interest - Please select all that apply

Direct patient and staff support on units

Visitor assistance

Infant, child and family programs

Wellness and health programs

Special projects and events

Administrative support

Serve on a committee

Home crafting

Pharmacy, PT and OT programs (Priority given to students pursuing degrees in these areas)

Animal assisted activities (Must have dog who is registered with Dogs on Call)

Please select all areas that apply

Availability

We have volunteer shifts available mornings, afternoons and evenings every day of the week depending on the volunteer placement. Please list your weekly availability to help us identify possible placement matches (for example - Saturday mornings, Wednesday afternoons, Friday all day):

Emergency Contact

* Contact name

* Phone

* Relationship

Agreements

All volunteers must pass a criminal background check. Have you ever been convicted of a crime other than minor traffic violations?

If yes, please list the date and nature of the offense :

Photo Release Waiver: as a UnityPoint Health-Meriter volunteer I recognize that my photo may be taken while I am volunteering to be used in marketing and promotional materials. If I am not comfortable having my photo shared, it is my responsibility to say so at the time the photo is being taken.

I certify that the statements made in this volunteer application are true and have been given voluntarily. I understand that this information may be disclosed to any party with legal and proper interest and I release UnityPoint Health-Meriter from any liability whatsoever for supplying such information. I understand I will not be paid for my services as a volunteer.

Signature