General Volunteer Application

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Volunteer

Applying for:

• Year Round Volunteer
• Temporary Volunteer

Which location are you applying to be a volunteer?

• Lincoln Campus
• Omaha Campus

First Name

Last Name

Middle Initial

Title

Mr. Ms. Mrs. Mx. Dr.

Preferred Name

Phone

Format: ###-###-####

Email

Address

City, State

Zip Code

Birthday

Emergency Contact Person

Relationship

Emergency Contact Phone

Students Complete This Section

School Attending

Area of Study

Are you seeking to complete a school requirement for volunteer services?

• Yes
• No

If yes, please describe, including total hours required and deadline for completion.

Have you ever been employed by Madonna Rehabilitation Hospitals?

• Yes
• No

If yes, in what capacity?

Are you currently employed?

• Yes
• No

If so, who is your employer and what is your occupation?

Have you volunteered at Madonna in the past?

• Yes
• No

If so, in what capacity?

Are you currently involved in volunteer activities elsewhere?

• Yes
• No

If so, for which organization(s) and position(s)?

Please tell us about any experience(s) you may have (employment history, volunteer work, education, personal experience) which you think may be helpful.

Desired Volunteer Opportunities

Helping Patients

Helping Residents (Lincoln Campus)

Mailings/Special Projects

Office/Clerical

Helping Visitors/Families

Have you lived in or traveled outside of the United States or an area with widespread disease in the last 30 days?

• Yes
• No

Have you ever been convicted of a crime (i.e., misdemeanor or felony)?

• Yes
• No

If yes, please explain and include dates.

Do you have any family members who are employed by Madonna?

• Yes
• No

If yes, please specify.

Do you need verification of your Madonna volunteer hours for a requirement?

• Yes
• No

If yes, please explain.

Please select the days you are most often available to volunteer.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Please select the times you are most often available to volunteer.

Morning

Afternoon

Evening

How did you hear about our volunteer program?

Volunteer Signature

Date

Submit