Volunteer Application Form

Personal Information

Where are you interested in volunteering?

Volunteer Type

* First Name

* Middle Name

* Last Name

Portrait Photo

* Address

Apt. #

* City

State

* Zip Code

* Cell Phone

Phone (Other)

* E-mail

* SS # (last 4 digits only)

* DOB

Current Student

School Name

How did you hear about our volunteer program?

Experience/Skills

Employer (if currently employed)

Work Experience/Skills

Volunteer experience/organizational memberships

Emergency Contact Information

* Emergency Contact

* Relationship

* Cell Phone

Phone (Other)

Other

Have you ever been charged or convicted in any criminal proceedings?

If yes, please explain

Please download, complete, and return the following required forms to the location of your preference. Contact information may be found under the Contact tab above.

*Medical Statement

Please click here to download the medical statement. Please return the completed form to the location of your preference.

*References (2 Required)

Please click here to download the reference form. Please return the completed form to the location of your preference.

*Background Check (18+)

Please click here to download the background check (18+ years of age). Please return completed form to the location of your preference.

MO Workers Safe Child Registry (Crittenton Applicants Only)

Please click here to download the form. Please return the completed form to Crittenton Children's Center.

KS Safe Child Registry (Crittenton Applicants Who Are Kansas Residents Only)

Please click here to download the form. Please return the completed form to Crittenton Children's Center.

Check the following to indicate your understanding:

* I voluntarily offer my service with a clear understanding that there is no monetary compensation.

* I understand that punctual and dependable attendance is expected.

* I am aware that SLHS will complete a Background Check (18+ years of age).

* I understand that a QFT-TB Blood test and Influenza Vaccine are required and will be provided through Volunteer Services.

* I understand that no tobacco products may be used at any SLHS location.

* I agree to adhere to the policies and procedures that have been established by SLHS.

* I understand that submitting this application does not guarantee volunteer placement as a SLHS volunteer.

* I certify that all of the information provided on this application is true, correct and complete. I understand that false, misleading or incomplete information on the application may result in my disqualification for volunteer service, regardless of the date of discovery.

[ clear ]

Applicant Signature (plus Guardian Signature if under 18 yrs of age). You can hold down the left mouse button to sign your name.

FOR YOUTH APPLICANTS ONLY: In signing this document, I give permission for the youth named on this profile to participate in the SLHS volunteer program. I verify the youth is 15-17 years of age and the information on this profile is correct. I understand that all of the profile packet's information will be kept confidental and is for office or emergency use only.

I am responsible for the purchase of a uniform. I take responsiblity for the youth's transportation, prompt arrival and departure for the scheduled shift. I understand it is the responsibility of the youth to notify Volunteer Services of changes.

I will give permission for the youth to recieve a TB blood test and Influenza vaccination administered by SLHS (no cost). I am responsible for the provision of a completed Medical Statement. In the event of illness or unjury and I am not avilable, I give permission for the youth to recieve appropriate emergency care.

I understand that effective August 1, 2011, Saint Luke's Health System no longer hires individuals who use tobacco products. By submitting this Application for Employement, I represent and agree (1) I do not currently use any tobacco product (including eCigarettes and vaping pens that contain nicotine), and (2) if offered employment by the System, I will not during that employment (including the timeframe from conditional offer to actual hire) use any tobacco product. I understand that use of a tobacco product of any kind during employement with the System is grounds for immediate termination of employment.

Saint Luke's Health System is an Equal Opportunity Employer. Services are provided on a nondiscriminatory basis.