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West Bloomfield Hospital Adult Volunteer Application Form
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Henry Ford West Bloomfield Hospital Adult Volunteer Applicaton Form
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Volunteer Opportunities
New User Details
User ID
User ID (verify)
Password
Password (verify)
Personal Information
What county are you interested in volunteering in?
Oakland County
*
At which Oakland County site(s) are you willing to volunteer?
Henry Ford Medical Center - Columbus (Novi)
Henry Ford Medical Center - Milford
Henry Ford Medical Center - Commerce
Henry Ford Medical Center - Farmington Road (West Bloomfield)
Henry Ford Medical Center - Waterford
Henry Ford West Bloomfield Hospital
If the site is not listed, please indicate here.
Are you 18 years of age or older?
Yes
No
*
First Name
MI
*
Last Name
Preferred Name
*
Home Address
*
City
*
State/Province
*
Zip Code
*
Preferred phone
Type
Home
Mobile
Work
Home phone
Mobile phone
Work phone
*
E-mail address
Contact flags
Do not SMS/text message
What is your Gender?
Female
Male
Other
Emergency Contact Information
*
Contact name
*
Relationship
*
Address
*
City
*
State
*
Zip Code
*
Preferred phone
Mobile phone
Home phone
Work phone
E-mail address
Additional Information
*
How did you hear about us?
Are/were you or a family member an employee or volunteer of HFHS?
Yes I am currently emloyed by HFHS
Yes, I was previously employed by HFHS
Yes, a family member is currently employed by HFHS
Yes, a family member was previously employed by HFHS
Yes, I currently volunteer for HFHS
Yes, I previously volunteered for HFHS
Yes, a family member currently volunteers for HFHS
Yes a family member previously volunteered for HFHS
No
If you or a family member were or are an employee or volunteer of HFHS, please explain here
Volunteer Preferences
Volunteer Work Objectives
Learn new skills
Have fun and relax
Develop skills
Explore careers
Make worthwhile use of free time
Help the community
Meet and work with people
Other
Other objectives
Skills (What skills would you like to utilize in a volunteer role)?
Administration/Office
Artist
Care Giver
Computer - Data entry
Computer - IT general
Crafts
Crocheting
Event Planning
Food Services
Fundraising
Gardening
Knitting
Language/Translator
Musician
N/A
Pet Therapy
Photography
Public Speaking
RN
Sewing
Writing/Reporting
Additional skills you are willing to share
Volunteer Placement Preferences
Behavioral Services
Bereavement Support
Blood Pressure Clinic
Children
Emergency
Epilepsy Monitoring
Facility Dog
Food Service- Prep & Serve
Food Service-Front of House/Kitchen Delivery
Friendly Visitor/Interview Patients
Greenhouse
Greeter/Escort
Healing Arts (Music art etc.)
Hospital Concierge/Front Desk
Infection Control Auditor
Intensive Care Unit
Magazine Cart
Maternal Unit
Medical Clinic/Patient Assistant
Neonatal intensive Care
Nursing Floor
Occupation Health
Office/Clerical
Oncology Host/Hostess
Oncology- Womens Health
Orthopedics
Other
Parking Services
Pastoral Care
Patient Care
Patient Feeding
Patient Transport
Pet Therapy (Own Dog)
Pharmacy
Rehab Services PT/OT
Rehabilitation
Retail
Special Projects (Events or Clerical)
Surgery
Urology
Women's Health Services
If other, please indicate interest(s) here
What are your physical and social preferences for a volunteer role?
Willing to walk long distances
Willing to push a wheelchair (if trained)
Willing to stand for extended periods of time
Prefer seated role
Prefer public/patient contact
Prefer no or limited public/patient contact
Availability & Time Commitment
How long can you commit to volunteering?
3 - 6 Months
6-12 Months
More than a year
How many hours would you like to volunteer per week?
4 hours
8 hours
More than 8 hours
Less than 4 hours
*
When would you like to begin volunteering?
Last available date to volunteer (if anticipated)
I do not anticipate an end date for volunteering at this time.
Weekday Availability
Monday
5am-9am
8am-Noon
Noon-4pm
4pm-8pm
Tuesday
5am-9am
8am-Noon
Noon-4pm
4pm-8pm
Wednesday
5am-9am
8am-Noon
Noon-4pm
4pm-8pm
Thursday
5am-9am
8am-Noon
Noon-4pm
4pm-8pm
Friday
5am-9am
8am-Noon
Noon-4pm
4pm-8pm
Weekend Availability
Sunday
8am-Noon
Noon-4pm
4pm-8pm
Saturday
8am-Noon
Noon-4pm
4pm-8pm
Experience & Education
Current Occupation
Employed
Retired
Student
Looking for work
Homemaker
Other
If other, please specify current occupation here
I am a student.
I attend school/college:
Communication Language
Afrikaans
Akan
Aklanon
Albanian
Algerian
Amharic
Arabic
Arawakan
Armenian
ASL
Avestan
Ayapathu
Aymara
Azeri
Bamwe
Bantu
Basa
Basque
Belarusan
Bemba
Bengali
Berber
Bicol
Bisaya
Bobangi
Bosnian
Brahui
Breton
Bukusu
Bulgarian
Burmese
Butuanon
Byelorussian
Cambodian
Cantonese
Catalan
Cayuga
Cebuano
Ch'ol
Chaldean
Chamorro
Chechen
Chewa
Chinese
Chinook
Chorti
Coptic
Cree
Creole
Croatian
Czech
Danish
Dari
Demonh'ka
Dothraki
Dutch
Ebu
Eggon
Egyptian
Emakua
English
Eskimo
Estonian
Etruscan
Fang
Faroese
Farsi
Filipino
Finnish
Flemish
Frankish
French
Fujanese
Fuzhounese
Gaelic
Gaelic (Irish)
Gaelic (Scottish)
Gaelic (Welsh)
Galician
Gamilaraay
Ganda
Gaulish
Gbari
Georgian
German
Gevove
Gilbertese
Gothic
Greek
Guarani
Gujarati
Guyanese Creole patois
Haida
Haitian
Hakka
Halaka
Hausa
Hawaiian
Hebrew
Hiligaynon
Hindi
Hmong
Hungarian
Icelandic
Igbo
Ilocano
Ilonggo
Indonesian
Ingush
Inupiat
Italian
Japanese
Jita
Kachi
Kakwa
Kalanga
Kannada
Kapampangan
Karelian
Kashmiri
Katcha
Kazakh
Kerewe
Khmer
Khowar
Kiga
Klallam
Klingon
Kongo
Konkani
Korean
Koyo
Kurdish
Lakhota
Latin
Latvian
Lebanese
Lingala
Lithuanian
Lozi
Luganda
Luwian
Lycian
Lydian
Mabwe
Macedonian
Malay
Malayalam
Maliseet
Maltese
Mandarin
Mandinka
Manx
Maori
Mapudungun
Marathi
Masaba
Mawu
Mayan
Mayangna
Miami
Minbari
Miskitu
Mixtec
Mohawk
Mongolian
Mpongwe
Nahuatl
Nande
Nauruan
Navajo
Ndebele
Nepali
Norwegian
Nyamwezi
Occitan
Ojibwe
Olkola
Olutec
Onondaga
Oriya
Oykangand
Pahlavi
Pakahn
Pali
Papiamento
Pashto
Pende
Persian
Phoenician
Phrygian
Pidgin
Piraha
Polish
Popoluca
Portuguese
Potawatomi
Prussian
Punjabi
Quechua
Rasta
Rejang
Romanian
Romany
Rotuman
Russian
Saanich
Sanskrit
Seneca
Serbian
Seri
Shanghainese
Shi
Shona
Signing Exact English
Sindhi
Sinhala
Slovak
Slovene
Sogdian
Somali
Sorbian
Spanish
Sranan
Sudovian
Sumerian
Swabian
Swahili
Swedish
Tagalog
Taishanese
Taiwanese
Tajik
Tamazight
Tamil
Tarahumara
Tarok
Tatar
Telugu
Teochew
Thai
Thracian
Tibetan
Tlingit
Tocharian
Tongan
Treu Chau
Turkish
Turkmen
Twi
Ukrainian
Ulwa
Umbrian
Urdu
Urdu
Uyghur
Uzbek
Venda
Veps
Vietnamese
Visayan
Votic
Warlpiri
Welsh
Wolof
Xhosa
Yaka
Yao
Yemba
Yiddish
Yoruba
Yupik
Zoque
Zulu
Additional languages
Afrikaans
Akan
Aklanon
Albanian
Algerian
Amharic
Arabic
Arawakan
Armenian
ASL
Avestan
Ayapathu
Aymara
Azeri
Bamwe
Bantu
Basa
Basque
Belarusan
Bemba
Bengali
Berber
Bicol
Bisaya
Bobangi
Bosnian
Brahui
Breton
Bukusu
Bulgarian
Burmese
Butuanon
Byelorussian
Cambodian
Cantonese
Catalan
Cayuga
Cebuano
Ch'ol
Chaldean
Chamorro
Chechen
Chewa
Chinese
Chinook
Chorti
Coptic
Cree
Creole
Croatian
Czech
Danish
Dari
Demonh'ka
Dothraki
Dutch
Ebu
Eggon
Egyptian
Emakua
English
Eskimo
Estonian
Etruscan
Fang
Faroese
Farsi
Filipino
Finnish
Flemish
Frankish
French
Fujanese
Fuzhounese
Gaelic
Gaelic (Irish)
Gaelic (Scottish)
Gaelic (Welsh)
Galician
Gamilaraay
Ganda
Gaulish
Gbari
Georgian
German
Gevove
Gilbertese
Gothic
Greek
Guarani
Gujarati
Guyanese Creole patois
Haida
Haitian
Hakka
Halaka
Hausa
Hawaiian
Hebrew
Hiligaynon
Hindi
Hmong
Hungarian
Icelandic
Igbo
Ilocano
Ilonggo
Indonesian
Ingush
Inupiat
Italian
Japanese
Jita
Kachi
Kakwa
Kalanga
Kannada
Kapampangan
Karelian
Kashmiri
Katcha
Kazakh
Kerewe
Khmer
Khowar
Kiga
Klallam
Klingon
Kongo
Konkani
Korean
Koyo
Kurdish
Lakhota
Latin
Latvian
Lebanese
Lingala
Lithuanian
Lozi
Luganda
Luwian
Lycian
Lydian
Mabwe
Macedonian
Malay
Malayalam
Maliseet
Maltese
Mandarin
Mandinka
Manx
Maori
Mapudungun
Marathi
Masaba
Mawu
Mayan
Mayangna
Miami
Minbari
Miskitu
Mixtec
Mohawk
Mongolian
Mpongwe
Nahuatl
Nande
Nauruan
Navajo
Ndebele
Nepali
Norwegian
Nyamwezi
Occitan
Ojibwe
Olkola
Olutec
Onondaga
Oriya
Oykangand
Pahlavi
Pakahn
Pali
Papiamento
Pashto
Pende
Persian
Phoenician
Phrygian
Pidgin
Piraha
Polish
Popoluca
Portuguese
Potawatomi
Prussian
Punjabi
Quechua
Rasta
Rejang
Romanian
Romany
Rotuman
Russian
Saanich
Sanskrit
Seneca
Serbian
Seri
Shanghainese
Shi
Shona
Signing Exact English
Sindhi
Sinhala
Slovak
Slovene
Sogdian
Somali
Sorbian
Spanish
Sranan
Sudovian
Sumerian
Swabian
Swahili
Swedish
Tagalog
Taishanese
Taiwanese
Tajik
Tamazight
Tamil
Tarahumara
Tarok
Tatar
Telugu
Teochew
Thai
Thracian
Tibetan
Tlingit
Tocharian
Tongan
Treu Chau
Turkish
Turkmen
Twi
Ukrainian
Ulwa
Umbrian
Urdu
Urdu
Uyghur
Uzbek
Venda
Veps
Vietnamese
Visayan
Votic
Warlpiri
Welsh
Wolof
Xhosa
Yaka
Yao
Yemba
Yiddish
Yoruba
Yupik
Zoque
Zulu
Highest education
College Grad (2-year)
College Grad (4-year)
College Grad (Doctoral)
College Grad (Masters)
College Student
Elementary Student
Graduate Student
High School Grad
High School Limited
High School Student
Home Schooler
Jr. High Student
Seminary Student
Skilled Trade Grad
Special - CBOT
Special - CLC
Special - KVOT
Unknown
Work Experience
I am employed.
I work at (employer):
1. Organization
Employee Job Title
Job Duties
Length of Employment
Less than 1 year
1 to 2 years
2 to 5 years
More than 5 years
2. Organization
Employee Job Title
Job Duties
Length of Employment
Less than 1 year
1 to 2 years
2 to 5 years
More than 5 years
Volunteer Experience
1. Organization
Volunteer Job Title
Job Duties
Length of Service
Less than 1 year
1 to 2 years
2 to 5 years
More than 5 years
2. Organization
Volunteer Job Title
Job Duties
Length of Service
Less than 1 year
1 to 2 years
2 to 5 years
More than 5 years
Comments & Other Info
Do you agree to be tested for TB and have a seasonal flu vaccine?
Yes
No
*
What do you hope to do as a volunteer?
Any additional information for us to consider?
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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 West Bloomfield Hospital. Misrepresentation of facts constitutes cause for separation from Volunteer Services. (Please electronically sign below)
