Advocate Christ Medical Center - Volunteer Profile Application



	4440 West 95th Street • Oak Lawn, Illinois 60453 • (Main) 708.684.8000 • TDD

Volunteer Program
at Advocate Christ Medical Center

Volunteer Profile Application

Please fill out this form as completely as possible.
If you have any questions, please call 708.684.5248.

Please indicate the reason you are seeking a volunteer position. (check all that apply)
	Personal fulfillment	Extra Time
	Family/Friends involved with medical center	Professional Development
	Requirement for class/degree	Possible future career
	Other

The following information is for statistical purposes and will not affect your volunteer placement.
Date of Birth :	/ /
Social Security Number :
Gender :	Male Female
Student :	High School College Neither Service Hour Requirement

Education :
High School	Undergrad Degree
Trade School	Graduate Degree
Do you speak a second language?
Yes	No
If yes, language(s) :

Times You Are Available. Please mark the boxes to show your availability.
	Morning	Afternoon	Evening
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

How did you learn about volunteer opportunities at Christ Medical Center?
Friend Employer Co–worker	Instructor Clergy Doctor	Website Newspaper Poster/Flyer
Other

Please list your previous work experience.

Are there any areas in the medical center where you would not feel comfortable working?

Yes No If yes, what are they?

Is there a particular type of volunteer work in which you are interested? (Check all that apply)
	Administrative/ Clerical work	Hospitality/ Information
	Indirect patient contact	Escorting/ Transporting
	Special Services (mail, flower delivery, special projects)

Reference

Name

Address

Phone

Emergency Contact (Must be listed)

Name of person to contact in an emergency

Phone number of this person

Relationship to you

http://www.advocatehealth.com

1.800.3.ADVOCATE / TDD 630.990.4700
También tenemos representantes que hablan español.