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Please fill out this form as completely as possible.
If you have any questions please call 1.847.723.6105.

* Indicates required information

Personal Information 

Title * 
Last Name * 
First Name * 
Street Address * 
Apt. No. 
City * 
State * 
Zip * 

Phone 

Cell: 
Home: 

Alternate Phone 

Cell: 
Home: 
E-mail Address * 
Date of Birth (mm/dd/yyyy) 
Current Employer / School 
Work Phone 
Have you ever been interviewed/scheduled for an orientation? * 
If yes, what is your orientation date: (mm/dd) 

Education 

 




Emergency Contacts 

Name #1 
Relationship #1 
Phone #1 
 
Name #2 
Relationship #2 
Phone #2 
Previous volunteer experience 

Please indicate the reason you are seeking a volunteer position (check all that apply) 

 




If Other, please specify:

Please list your qualities/skills that would benefit our volunteer program; and explain why you think you will be a good fit for volunteering at our hospital. * 

Which area would you like to volunteer (please rate them in order of preference)
Explanation of volunteer areas/opportunities 

First 

If Other, please specify:

Second 

If Other, please specify:

Third 

If Other, please specify:


 

When are you available to volunteer? 

Monday 
Tuesday 
Wednesday 
Thursday 
Friday 
Saturday 
Sunday 

 
How did you learn about volunteer opportunities at Advocate Lutheran General Hospital? 








If Other, please specify:

Hospital associate/volunteer's name 
Do you have any medical limitations on the type of volunteer work you can perform?  * 

If yes, please explain 

Personal References 

Name #1 
Relationship #1 
Phone #1 
Name #2 
Relationship #2 
Phone #2 
For 16 and 17-year-old candidates - do your parents/guardians approve of you volunteering? 


Have you ever been employed by or volunteered with Advocate Health Care * 


Worked - site and date 
Volunteered - site and date 
Have you ever been convicted of a crime, other than a traffic violation or misdemeanor, in the last seven years? * 

If yes, please explain 

 

Please read the following carefully 


 

Volunteer Requirement Agreement 

The volunteer assumes the responsibility of projecting a manner that is pleasant and helpful to the patients, the hospital staff, the visitors, or with whomever they come in contact. 

As a representative of the hospital, a volunteer is expected to adhere to all Advocate Lutheran General Hospital (ALGH) policies 

Placement in an area depends upon both the current needs and the new volunteer’s desires and skills. 

New volunteers are required to attend an orientation to learn hospital policies and procedures and correct ethics regarding patient interaction. Additional special orientations may be required to work in certain areas of the hospital. 

It is required that all volunteers complete a medical clearance screening that includes a TB test and verification of vaccination records prior to starting their volunteering. 

It is required that all volunteers take an annual PPD skin test for Tuberculosis. 

It is required that all volunteers consent to a criminal background check. 

The volunteer is expected to inform the volunteer office and the department as far ahead as possible if they are unable to work. 

The volunteer is responsible for maintaining the standard of work performance. 

Volunteers must wear a designated uniform while performing their volunteer duties. 

The volunteer must follow the appropriate dress code guidelines as discussed in the volunteer orientation. 

ID tags must be worn at all times. 

Smoking is not permitted anywhere on the hospital campus. Intoxicating beverages or illegal drugs should not be consumed prior to reporting on duty. Violation of any of these may result in immediate dismissal. 

The volunteer is responsible for keeping all information confidential, including, but not limited to a patient’s physical condition, financial status, personal problems, associate information, and Advocate business plans or strategies. 


 

I understand and fully acknowledge that in volunteering for Advocate Lutheran General Hospital, I am entering an AT WILL relationship and that this relationship can be terminated at any time by me or by Advocate Lutheran General Hospital 

I hereby affirm that the information provided on this application is true and complete to the best of my knowledge, and agree to allow any information provided in this application to be verified by the organization or its representatives. 

I understand that providing any false or misleading information or any omissions may disqualify me from further consideration as a volunteer and may result in my immediate termination even if discovered at a later date. 


 
I have read and I agree to the above: * 
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