Wyandotte Hospital 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

Mobile phone

Home phone

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):

Comments & Additional Information

* How did you hear about us?

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

How long can you commit to volunteering:

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

* 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 Wyandotte Hospital. Misrepresentation of facts constitutes cause for separation from Volunteer Services. (Please electronically sign below)

VSys Wyandotte Hospital Application