Volunteer

Name:*
First Middle Last
Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone:*
Email address:
Date of birth:*
Date Format: MM slash DD slash YYYY
Education:*
Check all that apply
- High School
- College
- Post-Graduate
Work Status:*
- Employed
- Retired
- Unemployed
Current Place of Employment:*
Employer Phone:*
Volunteer Availability (time):*
- Morning
- Afternoon
Volunteer Availability (days):*
- Sunday
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
Have you, since the age of 18, plead guilty or been convicted of a misdemeanor or felony charge, including any suspended imposition or execution of sentence?*
- Yes
- No
Please list 2 personal references (not related):
Reference 1 Name:*
Reference 1 Phone:*
Reference 2 Name:*
Reference 2 Phone:*
Referred by / reason for choosing to volunteer with Saint Francis:*
Would you like information about our Auxiliary?*
- Yes
- No
Emergency contact information:
Emergency Contact Name:*
Emergency Contact Phone:*
Emergency Contact Relationship:*
As a volunteer, I:
- Agree to complete the volunteer orientation and train until I am competent to perform the required duties
- Agree to complete an ANNUAL education review and employee health requirements as well as any additional service-specific training that may be deemed necessary
- Agree to comply with all the rules and regulations of Saint Francis Medical Center and to uphold the bylaws of Volunteer Services
- Understand that I may be dismissed from my duties for willful wrongdoing or negligence and/or performing duties outside of my service guidelines
- Agree to call Volunteer Services as soon as possible when I have scheduling changes
- Agree to accept assignment to a new service area if absent for an extended period of time
*
- I confirm that the information provided in this application is true in all aspects, without any willful omissions. I understand that if this application is false in any way I will be dismissed without notice regardless of when the false information is discovered.

Become a Volunteer

Volunteering offers adults the opportunity to serve their community, make new friends and enrich their lives. To volunteer, please fill out the online volunteer application form, or print and complete our printed application form, and return it to the Foundation office. For more information, call 573-331-5166.

Location and Information

Saint Francis Medical Center
211 Saint Francis Drive, Entrance 1
Cape Girardeau, MO 63703