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ADULT VOLUNTEER APPLICATION FORM
Best time to call
Do you check email regularly?
Name and address of person to be contacted in an emergency:
Name and phone number of primary physician:
How did you hear about our volunteer program?
If Other, please explain
Volunteer position/experience desired:
Have you ever previously been employed or volunteered at Lodi Memorial Hospital?
Briefly state why you would like to volunteer with Lodi Memorial Hospital:
Days/hours of week available
Are you available throughout the year?
Previous Work Experience
As a volunteer
As an employee
Please indicate below the skills and/or experiences you possess and would be willing to utilize in vounteering at Lodi Memorial Hospital:
Humor / storytelling
Board / Card Games
Drawing / Painting
Please list other skills and/or experiences:
Do you speak a lanuage other than English fluently?
If so, what language(s)?
Community Affiliations (clubs, other organizations):
Have you ever been arrested or convicted of a felony or misdemeanor?
If so, please explain nature of charges, when and disposition:
Please list two references other than family (Name, Address, Phone):