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**Saint Luke's South Hospital is no longer accepting student applications for 2018. This program is full. ** 

Please complete the following application to be considered for a volunteer assignment with Saint Luke's Health System. 

Fields outlined in red or marked with an asterisk are required. 

If you leave this page without submitting, your application will not be saved. 

New User Details

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:

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.