Volunteer Application

Penn Presbyterian Medical Center

Working side-by-side with hospital personnel, Penn Medicine volunteers are committed to making a difference in our hospital community. If you have a sincere interest in helping others, please complete the form below to be considered for a volunteer position at a Penn Medicine location. Volunteer Services will review all applications and contact qualified applicants.

Sign-Up:

New User Details

User ID

User ID (verify)

Password

Password (verify)

Are you applying as an Adult or a College volunteer?

Applicant Information

Title

* First name

Middle name

* Family/last name

Date of Birth

Local Address

* Street Address

Apt./P.O. Box/Suite

* City

State

* Zip/postal

Permanent Address

Street Address

Apt./P.O. Box/Suite

City

State

Zip/postal

Contact Information

Phone (Home)

Phone (Mobile)

Phone (Other)

* E-mail

Emergency Contact Information

* Emergency contact name

* Relationship to you

* Phone

Additional Information

Describe your interest in a volunteer position at Penn Presbyterian.

Are you currently seeking volunteer service to fulfill a community ir educational obligation (school, church, court referred)?

If yes, please describe the service requirements.

Community Service Organization Contact

Community Service Contact - Phone

Is there anything that may adversely affect your ability to perform volunteer work, or that would require an accomodation in order to safely and competently perform volunteer work as requested?

If yes, please describe, including details and accomodation requirements. The information you provide will be kept confidential.

Education
Please indicate the highest level of education completed.

High School

High School Name

High School Address

College

Graduate School

College Name

Degree or Major

Employment Experience - Penn Medicine
Please complete the following based on employment held within the last 10 years.

Have you ever worked for Penn Presbyterian Medical Center or any entity of Penn Medicine

If yes, work location

Dates of Employment

Employer Experience: Employer 1

Business Name

Status

Business Address

Business Phone Number

Position Title

Supervisor's Name

Volunteer Experience

Volunteer Agency Name

Positions Held

Volunteer Dates

Do you have any special skills or interest you would like to use as a volunteer?

Type of volunteer service preferred

Please indicate the days and times you are available to volunteer.

Monday

8am-Noon

Noon-4pm

4pm-8pm

5pm-9pm

Tuesday

8am-Noon

Noon-4pm

4pm-8pm

5pm-9pm

Wednesday

8am-Noon

Noon-4pm

4pm-8pm

5pm-9pm

Thursday

8am-Noon

Noon-4pm

4pm-8pm

5pm-9pm

Friday

8am-Noon

Noon-4pm

4pm-8pm

5pm-9pm

Reference #1 No relatives or personal physicians please. References can be from employers, professors, personal friends, previous Volunteer Services Directors, etc). Prefer at least one professional reference, if possible.

* Name

Relationship to You

Name of Business or School

Street Address

City

State

Zip/postal

* Phone

Reference #2 No relatives or personal physicians please. References can be from employers, professors, personal friends, previous Volunteer Services Directors, etc). Prefer at least one professional reference, if possible.

* Name

Relationship to You

Name of Business or School

Street Address

City

State

Zip/postal

* Phone

Criminal Background Check

Have you ever been convicted of a felony?

Have you ever been convicted of a misdemeanor?

If you answered Yes to either of these two questions regarding convictions, please describe the convictions(s) in detail, including dates.

Application Certification

I certify that the information I have provided on this application is true and complete to the best of my knowledge. I understand that misrepresentation, falsification, or omission of information may disqualify me from further consideration for volunteering, or may result in my termination as a volunteer at PPMC. If accepted as a volunteer, I understand that I must abide by all of the policies, rules and regualtions of the hospital.

I Authorize I authorize Penn Presbyterian Medical Center Volunteer Services Department to investigate all statements contained in this application and to make inquiries of my personal references and medical history, as well as other related matters as may be necessary for determining my eligibility as a volunteer. I hereby release employers, schools or individuals from all liability in responding to inquiries relating to my volunteer application.

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