Henry Ford Genesys Volunteer Application

Please complete the volunteer application and click on "save" to submit it.

Personal Information

* First Name

* Last Name

* Home Address

* City

* State

* Zip Code

* Phone (555-555-5555)

* E-mail Address

Please check if you are a year-round resident.

If not, what months are you available? Please note that we require a volunteer to be able to contribute at least six months of continuous service.

Please check to confirm that you are at least 15 years old

Gender

Are you a veteran?

Branch of Service

Emergency Contact Information

* Contact name

* Phone (must be different from your phone number)

* Relationship

Education

Grade Level Completed

Major/Degree

Other training, certificates, professional memberships, licenses

If you are a current student, please list:

School

Program

Advisor Name / Phone

Work Experience

Please list most recent first

* Employer 1

* Job Title 1

* Job Duties

Length of Service

* Reason for leaving

Employer 2

Job Title

Job Duties

Length of Service

Reason for leaving

Current Employment Status

Have you previously been employed in the Genesys Health System?

If yes, please explain

Has a family member previously been employed in the Genesys Health System?

If yes, please explain

Have you ever been disciplined, suspended or discharged from employment?

If yes, please explain

Is there further useful job-related data or information that you wish to have us know?

Volunteer Experience

Organization 1

Role/Duties

Length of Service

Organization 2

Role/Duties

Length of Service

Volunteer Objectives

Volunteer Work Objectives

If other, please specify

Preferred Activity Level

* Hobbies

Skills - Please check all that apply

Other skills, please specify

Placement

Please note that placements may have limited availability

Placement Preference

If other, please specify

Specific Volunteer Service Areas you are interested in

If other, please specify

If Pet Therapy is specified please provide dog's name, breed, and certification

* How did you hear about this volunteering opportunity?

Application Agreement: I certify that all information I have and will provide throughout the selection process, including on this application and in interviews with Henry Ford Helaht (HFH), is true, correct, and complete to the best of the knowledge. I understiand that information I provide may be verified and references may be contacted by HFH. I understand that misrepresentations or omissions may be cause for my immediate termination as a volunteer.

Agreement

By submitting this application on-line, I agree to the above written statement.

PLEASE CLICK 'SAVE' BELOW TO SUBMIT YOUR APPLICATION.