Volunteer Application

Volunteer Application

Naples Comprehensive Health Volunteer Department
Campus Choice

Ave Maria Immediate CareBonita Springs Emergency DepartmentCommunity Blood CenterDowntown Baker HospitalHSS @ NCHMarco Island Urgent CareNCH Business CenterNorth Naples CampusNortheast Emergency DepartmentGreentree Outpatient Rehabilitation Facility
Name*

PrefixFirst NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Years living at this address:*
Preferred Phone Number (Include area code)*
Please enter a valid phone number.
Email*
example@example.com
Are you over the age of 18?*
Resident Status*
Emergency Contact Information
Name*

PrefixFirst NameMiddle NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
Referral Method
How did you learn about volunteering at Naples Comprehensive Health?*
If Applicable, who were you referred by?

First NameLast Name
Education and Experience
Tell us about your education and/or professional experience.*
Are you currently enrolled in a college/trade school?*
Is this application for College Hours?*

YesNo
If yes, how many hours will you need?
If applicable, share your expected college graduation date.
If applicable, share current/former college/ trade school.
Degree
If applicable, share major/minor
Are/Were you a member of the United States Armed Forces?*

YesNo
Branch of Service
If applicable, please share highest held military rank and any other awards/recognitions:
Work Experience
Current/Former Occupation*
Employer/Former Employer*
Are you currently employed?*
Volunteer Intrests/Preferences
Please share your previous volunteer experience(s).*
How do you spend your free time? (Hobbies, interests, etc.)*
Computer Skills*

BasicIntermediateAdvanced
Are you proficient in any computer programs? If so, what ones?*
Please share any other professional skills.*
Please list any and all languages spoken.*
Getting to Know You
Why do you want to Volunteer at Naples Comprehensive Health?*
Tell us about a business or organization that provides world-class service. What makes them world-class in your opinion? *
Tell us about a time when you successfully worked as part of a team.*
Background Information
Have you ever been employed by Naples Comprehensive Health or any of its affiliates?*
If yes, please include date hired and department(s).
Check yes if other than a misdemeanor traffic violation, you have been charged with or convicted for a crime*

YesNo
If yes, explain and provide the location (County and State).
Check yes if you have been charged with an unresolved criminal charge. (Are you charged with a crime that has not resulted in a plea of guilty, court trial, deferred adjudication or dropping of the charge?)*

YesNo
If yes, explain and provide the location (County and State).
Are you currently on probation?*

YesNo
If yes, explain and provide the location (County and State).
Naples Comprehensive Health conducts criminal record checks on all incoming volunteers. This is done in accordance with the law and in an effort to enhance patient safety. Falsification or failure to disclose complete information will disqualify you from volunteer service. A conviction does not necessarily disqualify you from volunteer service.
Naples Comprehensive Health will provide your uniform, Tuberculosis Skin Test and Influenza Vaccination during flu season at no cost to the volunteer. More tangible benefits to volunteering with be presented at orientation.
I certify that the above information is correct and the background information has been completed.*

I agree
Please sign your full name.*

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Please fill in your full name. *

First NameLast Name
Printed?

Yes
Interviewed?

Yes
Processed?

Yes
Should be Empty:

Volunteer Application

Emergency Contact Information

Referral Method

Education and Experience

Work Experience

Volunteer Intrests/Preferences

Getting to Know You

Background Information

Naples Comprehensive Health will provide your uniform, Tuberculosis Skin Test and Influenza Vaccination during flu season at no cost to the volunteer. More tangible benefits to volunteering with be presented at orientation.