Online Volunteer Application

Place cursor on line and type in information. 
Use dd/mm/yyyy format for all date fields.
Required fields are marked with *. If you do not have information for a required field, enter "NA"
Please do not use any of the following characters/symbols when submitting your application:
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General Information*

Section 1 of 4

First name    Middle name    Last name
Street    City   State   Zip
Home phone    Work phone    Cell/Mobile phone(enter area codes)
E-mail
Have you ever been convicted of a felony? Yes   No
Category you are applying for* Junior Volunteer (Ages 15-18)   College Volunteer   Adult Volunteer
How often are you interested in volunteering?* Weekly   Monthly   Sporadically   
(Please note that most volunteer assignments require a weekly commitment.)
Please check what days you are available Mon  Tue  Wed  Thu  Fri  Sat  Sun
Morning   Afternoon   Evening 
Location desired General Hospital   Memorial Hospital     
Teays Valley Hospital
Women and Children's Hospital   
What kind of service are you interested in providing?*
 
Applicant Information

Section 2 of 4

 
Junior Volunteer Applicants
Parent/Guardian Information
Name        
Street    City   State Zip
Home phone    Work phone
                                                                                                                   
Applicant school information*
Name of School    Phone 
Last Grade Completed    School Counselor
Career Interest   School Activities
Adult / College Volunteer Applicants
Current, or most recent employment (if applicable)
Company    Phone   Position
May we call if necessary?   Yes   No
Have you ever been employed by CAMC Health System?   Yes   No
Name used while employed
When? from to  use dd/mm/yyyy format
Position held    Unit/Department
Past Volunteer Experience
Organization/Agency
Type of service provided                                                              
 
Education

Section 3 of 4

 
High school diploma or GED obtained*  Yes   No          Date of diploma/GED
High School    Location  
College    Dates of attendance                                         
College Major
 
References*

Section 3 of 4

(Please provide complete mailing addresses. Do not list relatives or anyone within your household.)
Reference 1
Name
Street    City    State    Zip
Home phone    Work phone (enter area codes)
Reference 2
Name
Street    City    State   Zip  
Home phone    Work phone (enter area codes)
 
Agreements and Notices
Believing that Charleston Area Medical Center has need of my services as a volunteer,
  • I certify that the answers given by me in the foregoing questions and statements are true and correct without consequential omissions. I understand and agree that  any misrepresentation in my application will be sufficient cause for cancellation of the application and/or separation from the organization.
  • I understand that this is an application for volunteer services and not a contract to provide those services.
  • I will hold absolutely confidential all information which I may obtain directly or indirectly concerning patients, doctors or personnel. I will not seek confidential information in regard to a patient.
  • I give Charleston Area Medical Center, Inc. permission to make a thorough investigation that my include the following: past employment. past volunteer experiences, education, education verification and criminal history. I authorize and release from liability or responsibility all persons, companies, schools and municipalities supplying any information regarding me whether or not it is a matter of record.
  • If selected as a volunteer, I understand that my services will be donated to CAMC Health System, Inc. without contemplation of compensation or future employment and given with humanitarian or charitable reasons.
  • I authorize CAMC Health System, Inc. to use and disclose information such as my name and photographs for the purposes of marketing, media and education.
Note: Filing an application does not assure placement since the number of applications usually exceeds the number of available openings. Applicants will be chosen by the Director of Volunteer Services on the basis of personal traits and qualifications in keeping with the best interests and current needs of the hospital.
Opportunities for volunteers are provided without regard to religion, creed, race, national origin, age, gender or disability.
For additional information, please contact Volunteer Services at one of the following locations:
For General, Memorial or 
Women and Children’s hospitals:
(304) 388-7426
For CAMC Teays Valley Hospital:

(304) 757-1891
By clicking submit you are stating that you have read and agree to the above information and terms.