Tuesday, March 09, 2010
Volunteer Application
PERSONAL INFORMATION
First Name
Middle Name
Last Name
E-Mail
Present Address
Street Address
P.O. Box
City
State
Home Phone
Zip Code
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Permanent Address (if different than present address)
Street Address
P.O. Box
City
State
Home Phone
Zip Code
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Emergency Contact
Name of Person
Phone
Relationship
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Reference Information
Name
Street Address
City
State
Home Phone
Zip Code
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AVAILABILITY (CHECK YOUR AVAILABLE TIMES)
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
Sunday Morning
Monday Morning
Tuesday Morning
Wednesday Morning
Morning
Morning
Morning
Sunday Afternoon
Monday Afternoon
Tuesday Afternoon
Wednesday Afternoon
Thursday Afternoon
Afternoon
Afternoon
Sunday Evening
Monday Evening
Tuesday Evening
Wednesday Evening
Thursday Evening
Friday Evening
Saturday Evening
WHAT ARE YOUR AREAS OF INTEREST
Oncology
Patient Registration Greeter
Clerical Support
Patient Visitation
Community / Public Relations
Pastoral Care
Magazine Distribution
Employee Wellness
Brochure Distribution
Community Health
Dietary Services
Surgery Waiting Area
Emergency Department
Physical Therapy
Gift Shop
Hospitality Cart
Information Desk (Hospital and Castrop Center)
Fundraising
Junior Volunteer (ages 16 to 18 -- summer only)
Other:
Birth Center
Why do you want to volunteer at O'Bleness Memorial Hospital?
List previous volunteer experience.
List community activities (church, clubs, school, athletics, etc.)
55 Hospital Drive, Athens, OH 45701-2302
Phone: 740-593-5551
