Seton Northwest Volunteers

Volunteer Application


I. Name:

Last: First:
Address:

Street:

City:

Zip Code:
Phone:

Home:

Work:

Cell:

e-mail:


If you are currently employed, please list place of employment:



If retired, who was your last employer?:



Name of Spouse: Retired: Yes No

In case of emergency, please indicate who could authorize medical care; We must have a relative / friend living in the area:

Name: (Last, First)
Address:

Street:

City:

Zip Code:
Phone:

Home:

Work:

Cell:


II. What days and times are you available to volunteer (please check all that apply):
Monday mornings
Tuesday mornings
Wednesday mornings
Thursday mornings
Friday mornings
Saturday mornings
Sunday mornings
 Monday afternoons
Tuesday afternoons
Wednesday afternoons
Thursday afternoons
Friday afternoons
Saturday afternoons
Sunday afternoons
 Monday evenings
Tuesday evenings
Wednesday evenings
Thursday evenings
Friday evenings
Saturday evenings
Sunday evenings


III. Please list your past and current volunteer experiences:

Organization Name:
Your Position:

Organization Name:
Your Position:

What did you like most about your volunteer experience:


What did you like least:



IV. Check all statements that you believe apply to you. This information will help us find the kind of volunteer experience that might be of interest to you.

I prefer to work alone.
I prefer routine tasks.
I prefer to do whatever is needed.
I prefer to work in a group.
I prefer an opportunity to meet and get to know other people.
I prefer to work one-on-one with patients.
I prefer to work directly with a staff person.
I prefer to do office work.


Please check those items in which you are experienced or have a desire to learn:

Accounting
Bookkeeping
Cashiering
Computer skills/word processing
Leadership
Patient Care
Telephone (answering, calling)
Filing
Crafts (crochet, knitting, sewing, flower arranging, making ribbons, etc.)
Other (Please specify):



V. Why are you interested in volunteering at Seton Northwest Hospital
and what would you like to get out of your experience here?


VI. How did you hear about volunteering at Seton Northwest?


VII. Please list name of any friends or relatives who volunteer at Seton Northwest:



VIII. Are you volunteering as part of a Community Service requirement that is a condition
of probation or parole? Yes No

If yes, was your offense a misdemeanor or a felony, and in what county were you convicted?
Misdemeanor Felony        County:



Signature: _____________________________ Date: ___________________________

Please print, sign this form and mail it to:

Volunteer Services
Seton Northwest Hospital
11113 Research Blvd.
Austin, TX 78759


Thank you for your interest in being a volunteer at Seton Northwest Hospital. We look forward to your assistance and interest in our hospital.

Please Note: The Director of Volunteer Services, after consulting with the Seton Northwest Volunteers President, has the right to dismiss a volunteer at any time for any reason, including inappropriate behavior, failure to follow Seton policies and procedures, and/or unreasonable conflict with patients, staff, or visitors.


Return to Seton Northwest Volunteers main page

SetonNW.org