VOLUNTEER APPLICATION FORM

We invite you to complete our online application form and will do our best to match you with a position that best utilizes your skills and interests. Please note that our volunteer application process can take up to a month. All volunteers must complete mandatory in-service training, show proof of immunizations, sign confidentiality statements, and provide references prior to providing services.

VOLUNTEER PERSONAL INFORMATION

Please enter your first and last name.

Please enter your date of birth (MM/DD/YYYY).

Please enter your e-mail address.

Please enter your street address.

Please enter your mailing address city.

Please enter the abbreviations for your mailing address state (e.g., ME).

Please enter your mailing address zipcode.

Please enter your primary phone number.

Phone

If available, please enter your secondary phone number.

Phone
Employment Status*

Please select the option that best represents your current employment status.

Please list what you do/did for work.

Please list any hobbies or interests you have that may be relevant to this volunteer experience.

Who recommended Volunteer Service at our organization to you?

VOLUNTEER OPPORTUNITIES

Please tell us what volunteer opportunities you have an interest in.

Organization Selection*

Please choose which organization you desire to volunteer with.

Please select any/all opportunities at MDI Hospital you would like to be considered for.

Please describe how you would like the volunteer at MDI Hospital that is not listed above.

Please select any/all opportunities at Birch Bay Retirement Village you would like to be considered for.

Please describe how you would like the volunteer at Birch Bay that is not listed above.

VOLUNTEER AVAILABILITY

Please provide some detail about your potential availability as a volunteer.

How often will you be available to provide services?

Select or enter value
Caret IconCaret symbol

What days of the week do you prefer to volunteer?

Please provide a time range for best availability (e.g., 9am - 1pm or 9:00 - 13:00).

BACKGROUND CHECK

Please be aware that we run background checks on all volunteers who may be selected for service.

Criminal Conviction or Community Service*

Have you been convicted of a crime or ordered to do community service?


Conviction of a crime does not necessarily disqualify applicants from consideration.

Please explain.

VOLUNTEER HEALTH

Health Limitations*

Do you have any limitations and/or health concerns that should be taken into consideration before determining a volunteer assignment?

Please explain.

EXPERIENCES & EDUCATION

Please provide some detail below regarding your past experiences, education, interests, and background.

Please list past volunteer experiences.

Please list any education, professional licenses, and/or certifications you currently hold.

Please list your interests, skills, and experiences that may be useful to you as a volunteer.

EMERGENCY CONTACT INFORMATION

Please provide one emergency contact below.

Please enter your emergency contact's first and last name.

Please describe your relationship with your emergency contact (e.g., sibling, spouse, parent, child, etc.).

Please list your emergency contact's street address.

Please list your emergency contact's city.

Please list your emergency contact's state.

Please list your emergency contact's zip code.

Please list your emergency contact's primary phone number.

Phone

If applicable, please list your emergency contact's secondary phone number.

Phone

FIRST REFERENCE

Please provide the details below for your first reference.

Please provide your first reference's first and last name.

Please provide your first reference's e-mail address.

Please provide your first reference's phone number.

Phone

Please describe your relationship with your first reference (e.g., co-worker, supervisor, friend, family, etc.).

SECOND REFERENCE

Please provide the details below for your second reference.

Please provide your second reference's first and last name.

Please provide your second reference's e-mail address.

Please provide your second reference's phone number.

Phone

Please describe your relationship with your second reference (e.g., co-worker, supervisor, friend, family, etc.).

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