Mid-Coast Hospital Volunteer Sign Up

Volunteers Have the Magic Touch!
APPLY ON-LINE TO SHARE YOURS!
Questions for the Volunteer Director?

PLEASE TELL US ABOUT YOU:

Name:

Mailing address:

E-mail address:
(Please double check. One out of ten contain typos!)

Phone number:

Please list your previous volunteer experiences, if any. No previous experience required!

Occupation/former occupation

Education/Special training

Hobbies/Skills/Special Interests

Is there anything else you would like us to know about you?

TELL US WHAT YOU'D LIKE:

Do you have a particular area you'd like to volunteer for? If so, please describe. (For a complete list of available positions, go here.)

Availability- please let us know when you may be available for volunteering

Days of week
Hours of day

Can you tell us where you heard about our volunteer opportunities and what prompted you to check them out?

PERSONAL REFERENCE:

Name

Address

Phone number

May we call the above address?

How does this person know you?

EMERGENCY CONTACT INFO:

Name:

Address:

Relationship

Home phone

Work phone

Rubella Immunization. It is Mid Coast Hospital policy that all volunteers born after Dec 31, 1956 are required to show proof of immunity to rubella disease. All non-immune volunteers will be required to be immunized against the disease, at no charge, in the employee health department.

Date of immunization:

You must also sign a confidentiality statement at the hospital.


Accredited by The Joint Commission. Recognized as a Magnet™ Hospital for exceptional nursing and patient care by the American Nurses Credentialing Center. (Learn more at www.midcoasthealth.com/quality)

123 Medical Center Drive, Brunswick, Maine 04011 Phone: (207) 729-0181
Copyright© 2008. Mid Coast Hospital. All rights reserved.

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