St. Mary's Volunteer Applications

St. Mary's Adult Volunteer Application

Thank you for your interest in the St. Mary's Volunteer program. Please review the requirements below and complete the Application.

Requirements:

Upon acceptance to the program, volunteers must provide the Volunteer Office with a copy of current immunization records. To comply with State of Maine mandates to work in a health care facility you must be immunized against Measles (Rubeola), Mumps, Rubella, and Varicella (Chicken Pox)

All Volunteers will need to have a TB test which can be completed free of charge at our WorkMed practice in Auburn.

Basic Information

* First name

Middle initial

* Last name

First name (preferred)

* DOB

Last 4 of SSN

How did you hear about the St. Mary's Volunteer Program

Contact Information

* Phone Number

* E-mail

Home Address

* Line 1

Line 2

* City

* State

* Zip/postal

Interests & Experience

* Job skills or special training:

* Prior volunteer experience

* What interests you about volunteering at St. Mary's?

Do you have any limitations or health conditions which should be taken into consideration before determining a volunteer assignment?

If yes, please list any limitations and accomodations you require here.

Do you have any relatives working in the St. Mary's Health System?

If yes, list your relatives working at St. Mary's including employee's name and department.

Emergency Contact

* Contact name

* Relationship name

* Phone (Mobile)

* Phone (Home)

References

Please provide two school, church, volunteer or work references. Please do not list any friends or relatives):

Reference 1

* Name

Relationship

Organization

* Phone

* E-mail

Reference 2

* Name

Relationship

Organization

* Phone

* E-mail

Availability and Preferred Roles

Volunteer shifts are from 8am-noon and noon-4pm. Please indicated the times you are available to volunteer below and your desired numbers you would like to volutneer each week.

Monday: 8am-12pm

Monday: 12pm-4pm

Tuesday: 8am-12pm

Tuesday: 12pm-4pm

Wednesday: 8am-12pm

Wednesday:12pm-4pm

Thursday: 8am-12pm

Thursday: 12pm-4pm

Friday: 8am-12pm

Friday:12pm-4pm

Job preferences, check all that apply.

Agreement to Requirements

* By checking this box, you confirm that you have read and understood the requirements for the Volunteer program listed at the top of this application. You also affirm that, to the best of your knowledge, you can meet the immunization requirements and time commitments outlined.