Healthcare at West Virginia University

Junior Volunteer — 14-18 attending high school.
Student Volunteer — 18+ attending a college/university.
Adult Volunteer — 18+ not attending a college/university.

Street Address:

Apartment/Address2:

City:

State:

ZIP Code:

Name:

Relationship:

Phone:

Have you ever been convicted of a crime or are you under charges for any offense against the law other than minor traffic violations?

Yes No

If yes, give details:

Prior experience as a volunteer:

How did you become interested in our hospital volunteer program:

Please list two professional references along with complete addresses.  Examples: employers, teachers, co-workers, ministers, etc.  If you are a Junior Volunteer, you will need to bring two written letters of recommendation to your interview.  Letters can be from teachers, coaches, ministers, someone from whom you've babysat, etc.
NO RELATIVES PLEASE!

Name:

Title:

Phone:

Street Address:

Apartment/Address2:

City:

State:

Zip Code:

Name:

Title:

Phone:

Street Address:

Apartment/Address2:

City:

State:

Zip Code:

Please select three options. Due to high demand, some positions are not available on a regular basis.

Working with children (must be 18+)

Child Development Center
Lobby Activity Volunteer
WVU Children's Hospital

Working with patients & families

Betty Puskar Breast Care Center
Cancer Center Lobby Liaison
Chestnut Ridge Day Hospital
Emergency Department
Patient Mail Service
Patient Representative
Rosenbaum Family House
Tea Service Volunteer
Visitation Volunteer

Clerical/office resource

Cheat Lake Physicians
Health Information Management
Library
Office/Resource Volunteer

Crafts

Diversional Therapy

Gift Shop
Information Desk

Do you have cash register experience?
Yes No

Rehabilitation Services (Pre-Physical & Occupational Therapy students only)

Occupational Therapy
Physical Therapy
Morgue & Anatomic Pathology

Security

Any available position

Other service request:

BELIEVING THAT WEST VIRGINIA UNIVERSITY HOSPITALS HAS NEED OF MY SERVICES AS A VOLUNTEER WORKER, I AGREE TO:

Hold as absolutely confidential all information, which I may obtain directly or indirectly concerning patients, doctors or personnel and I will not seek confidential information in regard to a patient.

My services are donated to West Virginia University Hospitals without contemplation of compensation or future employment and given with humanitarian or charitable reasons.

I grant permission for West Virginia University Hospitals Department of Volunteer Services to check the references I have provided.

If I am convicted of a crime other then a minor traffic violation after being hired as a volunteer, I will report this information in writing to Volunteer Services within 24 hours.

I hereby certify that my answers to the above questions are true, complete and correct.

Please note:
* Filing an application does not assure placement since the number of applicants usually exceeds the number of available openings.  The director of Volunteer Services will choose applicants based on personal traits, interview, and qualifications in keeping with the best interest of the hospital.