McLaren Port Huron – a leader in healing, your partner in health.
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Volunteer Application Form

Please Enter Your Information:
*Starred fields are required
Personal Information
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* (Please use xxx-xxx-xxxx format)
Work/Cell Phone: (Please use xxx-xxx-xxxx format)
How did you hear about our Volunteer Program?   
*  Yes No
     

Education
* High School:  1  2  3  4
College:  1  2  3  4
Post Grad:  1  2  3
*  Yes No
*  Yes No
*  Yes No

Employment Experience
*  Yes No
*  Yes No
Past Employment History: (list most recent)
Employer 1: Employer 2:
Position Held: Position Held:
Dates Employed: Dates Employed:
Reason for leaving: Reason for leaving:
Professional References (Please provide two references we may contact other than a relative)
Reference 1: Reference 2:
Phone: Phone:
Relationship: Relationship:

Availibility
Sunday  8-12   12-4   4-8  Thursday  8-12   12-4   4-8 
Monday  8-12   12-4   4-8  Friday  8-12   12-4   4-8 
Tuesday  8-12   12-4   4-8  Saturday  8-12   12-4   4-8 
Wednesday  8-12   12-4   4-8 
Anticipated length of Volunteer service:

Areas of Volunteer Interest
Special skills and interests: (Computer skills, public contact, office setting, etc)
Reason you would like to become a hospital volunteer:
Previous Volunteer experience:

Background
*  Yes No
If yes, list your probation officer's name and number:
*  Yes No
*  Yes No
If you answered yes to either of the previous two questions, please explain:
Please list any friends/relatives who are employed or who volunteer at McLaren Port Huron:
Name: Department: Relationship:
Name: Department: Relationship:
Name: Department: Relationship:
  

McLaren Port Huron offers equal opportunity to all based upon individual merit and without regard to race, color, religion, disability, age or sex. McLaren Port Huron is not obligated to provide a placement nor is the applicant obligated to accept the position offered.