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VOLUNTEER DEPARTMENT
(815) 489-4310


VOLUNTEER OPPORTUNITIES

Application

If you would like to join the volunteer team at SwedishAmerican Hospital, please complete the application below. Upon submitting, you will receive a confirmation page which you can print out for your records. If you have any questions, please contact us at (815) 489-4310.

Besides passing a background check, and receiving satisfactory recommendation from all other required documentation, successful applicants will sit for an in-person interview, and if accepted, complete orientation and training.

* Indicates Required Fields

Your Information:

* First Name:
 
MI:
 
* Last Name:

* Date of Birth:
   

* Address:


* City:


* State:


* Zip:


* Phone:
- -

E-mail:


Emergency Name:
 
Phone:
- -

Spouse's Place of Employment:
 
Phone:
- -

Employment History:

1.
Name of Company:


Type of Work:


Current Status:


2.
Name of Company:


Type of Work:


Current Status:



List Professional or Business Experience:


Education Information (Teen/College Student Only):

Name of School:


Physical Condition:

1.
Is there any activity that you have difficulty with that might make it hard to perform volunteer duties (such as extended walking, wheel chair transporting, etc.)?
Yes
  No

If yes, please explain:
2.
Do you have a known Latex allergy?
Yes
  No
  Unknown
3.
Have you had Chicken Pox or Varicella Vaccine?
Yes
  No
  Unknown
4.
Before you begin volunteering, you may be asked to see our employee health physician for further evaluation.

Please type your first and last name below as confirmation that you accept this:
Volunteering Information:

List Any Volunteer Experience (Organization, Type of Work and Reason for Leaving):


Reason for Volunteering at SwedishAmerican:


References:

Please give two (2) non-relative references that we may contact:
1.
Name:


Address:


City:


State:


Zip:


Phone:
- -

2.
Name:


Address:


City:


State:


Zip:


Phone:
- -

Volunteer Agreement:

I declare the foregoing facts to be truthful. I agree that if accepted as a volunteer, I will abide by SwedishAmerican Health System policies and that any violation of said policies shall be considered sufficient for dismissal.

*
Please type your first and last name below as confirmation that you accept this agreement:


Parent/Guardian Consent:

The information given on this application is correct and I agree to my child volunteering in the SwedishAmerican Health System.

Please type first and last name of parent/guardian below:


Phone number where parent/guardian can be reached:
- -

Contact Us
SwedishAmerican Health System
1401 East State Street
Rockford, IL 61104
(815) 968-4400
patientfeedback@swedishamerican.org

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