Welcome to St. Peter's Health Partners

SPHP/Acute Care Volunteer Application (Sunnyview)

Please complete all fields as thoroughly as possible. We want to be sure to make the best fit for you and for our organization. Your success is our success! APPLICANTS MUST BE AT LEAST 16 YEARS OF AGE TO APPLY.

Personal Information

* Application Date

* First Name

MI

* Last Name

Suffix

Preferred First Name

Preferred Pronouns

* Home Address

Apartment #

* City

* State

* Zip Code

* Home Phone

* Cell Phone

Work phone

* E-mail Address

* DOB (MM/DD/YYYY)

Emergency Contact Information

* Contact name

Address

City

State

Zip Code

* Home Phone

* Cell Phone

Work Phone

E-mail

Volunteer Profile

How did you hear about opportunities with St. Peter's Health Partners?

* If someone referred you to us, please provide the person or organization name. (If volunteering with us was not recommended to you by anyone, please put self-referred).

Why are you interested in volunteering with St. Peter's Health Partners?

Prior Volunteer Experience (please briefly list activities or organizations).

What area are you most interested in?

Which volunteer group best describes you? Select ONE. (Adult, College Student, High School Student, or NEW VISIONS ONLY)

Education and Employment

* If you are a student, what high school or college/university do you currently attend? (If you are not a student, you can list N/A, Unemployed, or Retired).

If you are a college student, please indicate your degree program.

What is the highest level of education you have completed?

Current Employer

Are you required to volunteer for service hours? If yes, please explain.

Availability (Most volunteers are asked to complete at least 1 shift per week, approximately 4 hours).

What days are you available to volunteer?

What shifts are you available to volunteer? (mornings, afternoons, or evenings)

References (Please provide 2 professional or personal references. NO RELATIVES please).

* Name

Relationship

* Phone

E-mail

* Name

Relationship

* Phone

E-mail

St. Peter's Health Partners is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status.

I certify that the statements made in this volunteer application are true and correct, and have been given voluntarily. I understand that this information may be disclosed to any party with legal and proper interest, and I release the hospital from any liability whatsoever for supplying such information.

By saving (submitting) this application, I agree to undergo and pass all applicable state and federally mandated screening requirements. This is for the safety and security of our colleagues and patients. I understand that volunteering is contigent upon completing the application and all applicable screening requirements:

Relevant background checks (Health and Human Services - Office of Inspector General which maintains the List of Excluded Individuals and Entities, General Services Administration System for Award Managment, sex offender registry at US Department of Justice National Sex Offenders Public Website, New York State Department of Corrections and Community Supervision Inmate Population and Federal Bureau of Prisons Inmate Search)
Reference check
Submission of required health documentation

I understand that I will not be paid for my services as a volunteer.

I understand that by saving (submitting) this application I am effectively signing electronically, and that it is equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature.

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

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