Volunteer Services Application

Only applications throughly completed will be considered for review

Contact Information

LEGAL NAME

Emergency contact

IN CASE OF EMERGENCY, WHOM SHOULD WE CONTACT?

Tell us about your availability

Please be specific. Minimum of 4-8 hours per week depending on campus.
With which population would you like to volunteer? (check all that apply)
In order of preference, list departments/programs that most interest you. See campus specific opportunities at nyp.org/volunteer.

Education Information

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

What college/university do you or did you attend?

Other education, certifications or licenses?

Employment or Volunteer Experience Information

Please list most current experience first.

Employer/Volunteer Organization #1

Employer/Volunteer Organization #2

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.

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?

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.