Volunteer Application

HILLVIEW HEALTH CARE CENTER

VOLUNTEER APPLICATION

I. Name Date:
	(Last)	(First)


Address:
Home Phone: Best Time To Call:
Emergency Contact (name and phone number):

Relationship:

References: (non-relatives; list names, address, and phone; students - list your instructors);

1.	2.


II. This section for college students only.

School: Major:
Class requiring volunteer hours: Hours required for classwork:


III. Frequency with which you wish to volunteer. (check preference)

Weekly (1,2, or 3 days)	Every Other Week	Weekends Only

Monthly	Other:

IV. Time Preference/Skills/Abilities. (check preference)

Mornings:	Afternoons:	Evenings:
9:00 a.m. - 1:00 a.m.	1:00 p.m. - 4:00 p.m.	6:00 p.m. - 8:30 p.m.

ALL VOLUNTEERS MUST GO THROUGH A 1-HOUR ORIENTATION SESSION.

Days of the Week Preferred:

Any skills, hobbies, or previous experiences you would like to share:


Any physical limitations: Yes No

If yes, please explain:


I understand that it is my responsibility to keep confidential any information I learn about the
residents and/or their family, and that violating confidentiality is cause for immediate dismissal.

Signature: _________________________________________