Volunteer Application

Mission

Madonna Rehabilitation Hospitals are Catholic hospitals that provide physical medicine and rehabilitation services to children and adults throughout the nation. We rehabilitate those who have sustained injuries or disabling conditions so they can fully participate in life; lead research to improve outcomes; and prevent physical disabilities and promote wellness through community programs.

Core Values

Madonna Rehabilitation Hospitals are dedicated to the healing ministry of Christ. In the spirit of our Catholic heritage and Benedictine traditions, we commit ourselves to the Core Values of:

Collaboration Hospitality Respect Innovation Stewardship Teaching

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

Preferred Name

Phone

Email

Address

City, State

Zip Code

Birthday

Emergency Contact Person

Relationship

Emergency Contact Phone

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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 ever lived in or traveled to a country with widespread Ebola virus transmission or had contact with an individual with confirmed Ebola virus?

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.

How did you hear about our volunteer program?

Volunteer Signature

Date

Volunteer Application

Volunteer

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