Macomb Application

Personal Information

What county are you interested in volunteering in?

Are you 15 years of age or older? (15 yrs. is our minimum age requirement)

* First Name

* MI

* Last Name

* Preferred Name

* Home Address

* City

State (as combo)

* Zip Code

* Preferred phone

Type

* Mobile phone

Home phone

Work phone

* E-mail address

Contact flags

What is your Gender?

Emergency Contact Information

* Contact name

* Relationship

* Address

* City

* State

* Zip Code

* Preferred phone

Phone (Mobile)

Phone (Home)

Work phone

E-mail address

Experience & Education

Communication Language

Additional languages

Highest education

I am a student.

I attend school/college:

I work at (employer):

Tell us about your current or most recent employer:

* What organizations have you volunteered with?

What abilities or strengths do you have that would be helpful as a volunteer?

Comments & Additional Information

* What date would you be available to begin your volunteer role?

Are you willing to commit to volunteering 4 hours per week for 15 or more weeks?*60 hours minimum commitment is required.

* How did you hear about us?

Reason for wanting to volunteer or what you hope to do as a volunteer?

Do you agree to be tested for TB and have a seasonal flu vaccine?

Upload Add'l File

* I certify that responses on my online application are true to the best of my knowledge. I agree that this information may be verified and references contacted by Henry Ford Macomb Hospital. Misrepresentation of facts constitutes cause for separation from Volunteer Services. (Please electronically sign below)

VSys Macomb Application