Request to Volunteer at Renown Renown Health

Please check the appropriate box
- Adult Volunteer
- College Volunteer
- High School Volunteer
- Other
If other, please specify.
First Name*
Middle Name*
Last Name*
Address
Street Address Address Line 2 City State ZIP Code

Please include apartment, unit or suite number if applicable.
Home Phone Number
Cell Phone Number*
Email*

VOLUNTEER TIME REQUIREMENTS AND AVAILABILITY
Minimum Commitment: Commit to a twelve (12) month period, able to work one shift per week. College and Adult volunteers are required to work one 4-hour shift and current high school students are required to work one 2-hour shift per week. Availability to volunteer during the timeframe of Monday - Friday 7am- 7pm Requirements Subject to Change
What days of the week are you available?*
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
What is your availability on Mondays?
What is your availability on Tuesdays?
What is your availability on Wednesdays?
What is your availability on Thursdays?
What is your availability on Fridays?

Emergency Contact Information
Name*
First Last
Relationship
Address
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone*

General Information
In order for us to provide a satisfying experience for you in Volunteer Services, it helps to know a little more about you.
Please tell us about your hobbies, sports or special abilities, achievements, honors and/or awards.*
How did you hear about becoming a Renown Volunteer?*
What are your goals for volunteering at Renown Health?*

Eligibility
Are you a United States citizen or an alien authorized to work in the U.S.?*
- Yes
- No
Have you previously been an employee or volunteer for the Renown Health System?*
- Yes
- No
If yes, please state the organization, assignment, dates, status (employee or volunteer) and name while employed*
Have you ever been convicted or found guilty by any court of a felony offense or any gross misdemeanor or simple misdemeanor offense other than a minor traffic offense?*
- Yes
- No
(“A conviction shall include a plea, verdict or finding of guilty…” Labor Code 432.7) A conviction will not necessarily disqualify an individual from the volunteer program. Driving under the influence of alcohol and/or drugs and reckless driving must be disclosed.
If Yes, please state the nature of each offense, the date of conviction and the disposition*

Volunteer Acknowledgement & Agreement
As a Renown Health volunteer I agree to uphold the values of the organization by providing a high standard of quality service to our patients and staff. I agree to hold absolutely confidential all information that I may obtain directly or indirectly concerning patients, doctors, or personnel. I can be depended on to work my assigned shift and will call, in advance, if not able to fulfill that obligation. Three (3) no-call no-shows will result in termination from the program. I will commit to volunteering for the next twelve (12) months. I will wear the proper uniform as outlined in the orientation packet. I understand that I will be expected, before placement, to complete the volunteer orientation and required health screening.
By checking "I Agree", I acknowledge that I have read and understand the statements above. The information provided in this application is true in all respects without any willful omissions. I authorize Renown Health System to obtain a background check and a personal reference. 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.*
- I Agree
- I Disagree
The organization is not obligated to provide a placement, nor are you obligated to accept the position offered. A volunteer position does not constitute an employee-employer relationship with the medical center.

Opportunities for volunteers are provided without regard to color, race, religion, age, creed, national origin, sex, disability, veteran or marital status. In accordance with the Immigration Reform and Control Act of 1986, all offers of service (volunteer) are conditional upon satisfactory proof of the applicant’s identity and legal ability to work in the United States.

Request to Volunteer at Renown

VOLUNTEER TIME REQUIREMENTS AND AVAILABILITY

Emergency Contact Information

General Information

Eligibility

Volunteer Acknowledgement & Agreement

How is Book Ahead Calculated?