Volunteer Application

Personal Information

LEGAL NAME

* First

Middle name

* Last

Preferred name

* Last 4 digits of SSN

* Address/ House Number + Street

Apt. #

* City/Town

State

* Zip

Phone (Cell/Mobile)

Phone (Home)

Preferred phone type

Email:

Are you 18 years of age or older?

Please note: YOU MUST BE A MINIMUM OF 16 YEARS OF AGE TO APPLY.

Previous Volunteering

Have you ever volunteered at NewYork-Presbyterian Hospital?

If yes, when?

Which department?

Why did you leave?

Emergency contact

IN CASE OF EMERGENCY, WHOM SHOULD WE CONTACT?

* Name

* Relationship

* Phone (Preferred))

Tell us about your availability

Please be specific. Minimum of four consecutive hours per week.

Area(s) of preference

With which population would you like to volunteer? (check all that apply)

Requested site

In order of preference, list departments/programs that most interest you. See campus specific opportunities at nyp.org/volunteer.

* Program Choice #1

Program Choice #2

Program Choice #3

Who referred you to us?

Do you have any physical, mental or medical condition, which would limit your ability to perform the functions of a volunteer?

If yes, please describe.

Are you required to volunteer?

If yes, what is the reason?

What are the requirements (i.e. hours, type of placement)?

Employment or Volunteer Experience Information

Please list most current experience first.

Employer/Volunteer Organization #1

Company or Organization Name

From

To

Reason for Leaving

Title, tasks and/or duties

Name and title of Supervisor

Telephone

May we contact Supervisor?

Employer/Volunteer Organization #2

Company or Organization Name

From

To

Reason for Leaving

Title, tasks and/or duties

Name and title of Supervisor

Telephone

May we contact Supervisor?

Education Information

If you are currently in high school, please tell us what school you attend.

High School

Grade

What college/university do you or did you attend?

College

Major

School location

When did you attend?

Graduation date

GPA

Degree completed

Other education, certifications or licenses?

1. School

Certificate, License, Degree

2. School

Certificate, License, Degree

Volunteer Character Reference

APPLICATIONS MUST INCLUDE A COMPLETED VOLUNTEER CHARACTER REFERENCE IN ORDER TO BE REVIEWED. (Family members should not act as a reference)
I authorize NewYork-Presbyterian Hospital, or any agent it expressly authorizes to act on its behalf, to investigate fully all the information and references contained on my application for a volunteer opportunity. I release my current employer as well as former employees and other appropriate references from any liability and responsibility for providing written or verbal information about me to NewYork-Presbyterian Hospital.

* Reference - Name

* Phone

* E-mail

Personal Statement

At NYPH our initiatives support our ultimate goal: We Put Patients First. This means that in everything we do, we must make patients our first priority and strive to provide them with the highest quality, safest, and most compassionate care and service. How can you help us further this initiative as a volunteer?

* Personal Statement

Please read the following statements carefully, as they represent matters of importance to you and to NewYork-Presbyterian Hospital in connection with this volunteer application . After you have read the form in its entirety, please sign below.

I understand and agree that:

The information provided in this application, in my resume (if supplied) and during my interview(s) is true and complete to the best of my knowledge. I understand that any false or misleading statements on this application, on my resume, on any prescreening documents or in my interview(s) will justify refusal of volunteer status or, if I am hereafter on boarded by NewYork-Presbyterian Hospital, termination of my volunteer status.
NewYork-Presbyterian Hospital may verify all of the information that I have provided on this application and I release NewYork- Presbyterian Hospital and its representatives from liability for seeking such information and I release from all liability whatsoever any and all persons, institutions, business entities, and corporations providing NewYork-Presbyterian Hospital with such information. I further agree to sign whatever consent forms may be necessary to permit NewYork-Presbyterian Hospital to verify all of the information that I have provided in this application.
I understand that falsification or omission of information on my application may result in my immediate dismissal.
I understand that in accordance with New York State law, if I am offered a volunteer opportunity I will be fingerprinted and that such offer and continued volunteering are conditional upon satisfactory clearance by the Hospital's Workforce Health & Safety Department, which includes drug testing, and satisfactory reference verification and other general information provided on this volunteer application. I understand that if I am offered a volunteer opportunity, my volunteering will be "at will," meaning that either I or NewYork-Presbyterian Hospital may end the volunteer relationship for any lawful reason, at any time, with or without notice.

In consideration of any volunteer opportunity which may be offered to me, I agree to comply with the policies, rules, regulations and procedures of NewYork-Presbyterian Hospital.

My name typed below will stand as my signature, confirming the completeness and accuracy of the information I provided above, and will carry the same force and effect as if it were signed and affixed by my hand.

* Typed name

[ clear ]

Signature

Volunteer Application - NYP

Volunteer Services Application