Adult Volunteer Application

College Students will not be accepted through this form. If you are a currently enrolled in a college program, please apply through the college form: CLICK HERE

To protect the safety of our staff and patients, PMPH requires all staff to be fully vaccinated against COVID-19 (primary vaccine+booster) prior to start date and to receive an annual flu vaccine (during flu season), unless they have received an exemption based on an approved request for a medical or religious reasonable accommodation.

Updates Coming in Nov.

- Pre-Health Professional Program
- Pet Therapy at Penn Medicine Princeton Health
- Return Students
- Current volunteers
- Shadowing and Observation Opportunities

Applicant Information

* First name

* Family/Last name

Preferred First Name (if different from your legal name)

Middle name

DOB (optional)

Address

* Street Address

Apt./P.O. Box/Suite

* City

State

* Zip/postal

Personal Contact Information

* Phone (Primary)

Phone (Other)

Preferred phone type

* E-mail

Emergency Contact Information

* Emergency Contact Name

* Relationship to you

* Phone

Referral and Motivation Information

How did you hear about our program?

Main reason for wanting to volunteer

Do you have a current or previous affiliation with PMPH?

If you have been a patient,caregiver,volunteer, or have a current/previous affliation to the hospital please select all that apply.

* Please tell us why you are interested in serving as a volunteer with Penn Medicine Princeton Health. Be sure to include areas of interest or specific assignment requests that you would like us to consider.

Education

Please indicate the highest level of education completed.

Education

College Attended

Major Degree

Year Graduated (or anticipated Graduation Year)

Employment Experience - Penn Medicine

Please indicate whether you were previously employed, currently employed, or never employed by Penn Medicine Princeton Health.

If yes, work location

Dates of Employment

Reason for leaving

Skills & Experience

In order to provide you with the best experience possible, we utilize a database that matches your traits, skills and experience with available opportunities. Please check all that apply:

* Availability In the space provided, indicate the days and times you are usually available to volunteer. If you reside in another area during certain parts of the year, include the times of year when you are able to volunteer.

Application Certification
By checking the boxes below, I consent to the below statements and certify that all information in this application is true and correct as of todays date:

* I give permission for any necessary medical treatment to be given in the event of illness or an injury.

* I understand that any misstatement, omission or misleading information given in my application or interview or in connection with other PHPM records may result in the rejection of my application, the withdrawal of any offer of placement or dismissal after acceptance.

* I understand that a volunteer assignment and any related documents are in no way a contract, promise, or consideration of paid employment. I know that I will not be compensated for my service.

* I agree to commit to the required amount of time for the assignment in which I am placed (requirements vary for each assignment). I understand that no references will be completed on my behalf until I have served at least one-hundred (100) hours of volunteer service.

* I release from all liability and responsibility all persons and entities, requesting or supplying information about any information provided on this application, including my present employer if contact is authorized. Upon leaving my service with PMPH, I authorize the release of information in connection with my volunteer service.

* I grant permission to PMPH to conduct a background check on me including a check of my education, employment, volunteer service, licensure, driving, criminal records and personal and professional references. I understand that if I am rejected for volunteer service based upon information contained in these records, I will be notified and may obtain a copy of the report upon my request.

* I understand that I am required to complete PMPH volunteer orientation and any training requirements for the position(s) I am placed into, as in effect from time to time.

* I hereby authorize and permit PMPH to take, obtain and make use of photography and publicity of myself, as it relates to my volunteer service. I understand that such photography, interviews, and information may be used for inclusion in media reports and in PMPH publicity materials and publications that have been discussed with me prior to their publication. I understand that this will be done without compensation to me.

* If accepted, I will abide by PMPH rules, regulations, policies and procedures, which I understand are subject to change by PMPH.

* I agree to notify PMPH if any of the information I provide during the application, interview and on-boarding process changes at any time during the course of my service with PMPH.

* I understand that my volunteer service may be terminated at any time, with or without cause, in PMPH sole discretion.

I understand that I must submit two completed reference forms in order for my application to be considered complete. I also understand that if these forms are not turned in within 90 days that my application will be declined and I will have to reapply.

Princeton Health is an Equal Opportunity and Affirmative Action employer. Candidates are considered without regard to race, ethnicity, color, sex, sexual orientation, gender identity or expression, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

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* Name (First Name Last Name)