Welcome to Corewell Health Volunteer Services

Corewell Health Lakeland Caring Circle Volunteer

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Corewell Health Lakeland Caring Circle Volunteer
Hospice Care

Personal Information

* First Name

Middle Name

* Last Name

Preferred Name

* Date of Birth

Current Address

* Address Line 1

* City

* State

* Zip/Postal

Permanent Address (only if different than current)

Address Line 1

Address Line 2

City

State

Zip/Postal

Contact Information

* Preferred Email Address

Home Phone

Mobile

Work Phone

May We Text You? (Check if Yes)

Preferred Phone Number

Emergency Contact Information

* Name

* Relationship to You

* Home Phone

Cell Phone

History

Have you ever been convicted of a crime?

If yes, please explain:

Are you eligible to work in US?

Are you a US Citizen?

If no, documentation may be required at a later time.

Education/Employment

Highest Level of Education Completed

College/University

Degree Field/Area of Study

Are you a current student?

Are you required to volunteer (i.e. high school or college requirement)?

Please explain:

Are you receiving credit for volunteering (i.e. college course)? Check box if yes.

Please explain:

Are you currently employed?

Current/Most Recent Employer

Position/Title

Have you ever been employed by Corewell Health?

If yes, please list the dates, role, entity, and department you worked in.

Have you ever volunteered at Corewell Health?

If yes, please list the dates, role, entity, and department you volunteered in.

If you have worked or volunteered at Corewell Health under a different name (i.e. maiden name), please list it below:

Is there any employment and/or volunteer experience you would like to share with us?

Volunteer Interest

* Please explain your interest in volunteering at Corewell Health:

Additional Languages Spoken

How did you hear about us?

Where are you interested in volunteering?

How long are you willing to commit to volunteer?

Availability (check all that apply)

References

Reference #1 (No family members please)

* Name

Relationship

Address 1

City

State

Zip/Postal

E-mail

Phone

Reference #2 (No family members please)

* Name

Relationship

Address 1

City

State

Zip/Postal

E-mail

Phone

Agreement and Electronic Signature

Please Read the Following Statement Carefully Before Signing to Indicate Your Understanding:

I certify that I am able to perform the essential duties of the volunteer position. In the event that I have a disability that will affect my ability to take an assignment, I will inform Corewell Health Hospice prior so that reasonable accommodations can be made. Corewell Health Hospice reserves the right to require medical documentation regarding the need for accommodation.

I certify that the facts in this application are true and complete to the best of my knowledge and understand that falsified statements on this application may result in termination as a volunteer.

I understand and agree that my volunteering is for no definite period and may be terminated with or without case, at any time, with or without notice.

I authorize investigation of all statements contained in this application. I release the listed references to provide you with any and all applicable information they may have. I hereby release these references from all liability for any information they may give to Spectrum Health Hospice.

* Electronic Signature (type your full legal name in the box below)

Thank You for taking the time to fill out an application to volunteer at Corewell Health Lakeland Caring Circle!

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