Advocate Christ Medical Center
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Adult Volunteer Application (18 years and older)
* Indicates required information
Name * 
Email Address * 
Street Address 1 
Street Address 2 
City 
State 
Zip 
Home Phone Number 
Work Phone Number 
Date of Birth (MM/DD/YYYY) * 
Social Security Number * 
Gender * 
Emergency Contact 
Name * 
Phone Number * 
Relationship to you * 
Are you looking to satisfy community service hours through volunteering? * 
If yes, how many? 
Have you ever been convicted of a crime other than a traffic violation? * 
If yes please explain 
Service/Area of interest * 






Day(s) of availability * 






Hours of availability * 


If Other, please specify:
Are you currently enrolled in school? * 


Highest level of education completed * 



Do you speak a second language? (Please list them) 
Please list your previous work experience * 
Authentication * 

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  • I realize that without my full support the Volunteer Services Department of Advocate Christ Medical Center will not be able to fulfill its purposes of providing volunteer services in the hospital and promoting health and welfare in the community, I therefore agree to the following:
  • I will volunteer a minimum of (2) to (4) hours a week. I understand that there is a 100 hour minimum requirement to be considered for personal or professional references.
  • I will take any problems, criticisms, or suggestion to the Coordinator of Volunteer Services.
  • I will consider all information which I may hear directly or indirectly concerning a patient doctor, or any member of the hospital personnel, as confidential. I will not seek information regarding a patient.
  • I will uphold the tradition and standard of Advocate Christ Medical Center and abide by all Advocate Christ Medical Center confidential and security policies and procedures and adhere to the Behavior of Excellence.
  • I will notify the volunteer office if I am unable to be present for my shift. I understand that 3 misses without an excused absence will result in termination from the volunteer program.
  • I understand that I am required to complete a health information form and take a 2 step PPD skin test for Tuberculosis prior to starting as a volunteer.
  • I understand that all volunteers are required to receive annual PPD skin tests for Tuberculosis as well as influenza vaccinations.
  • I will wear a designated uniform while serving as part of the ACMC team, following the appropriate dress code guidelines as discussed in the volunteer orientation. I will wear my ID tag at all times while on the medical campus.
  • If I am assigned to a department or area and that requires me to have access to a computer, I will only use the computer for the work described in the job description I am given and not for personal use.(i.e. Internet, Music, Games, e-mail, etc.)
  • I understand that cell phones, I-Pods and all other electronic hand held device are not to be taken with me to my work area and are only permitted in designated areas when I am on break or lunch. I further understand that any violation of this policy will mean immediate dismissal.
  • I understand that Smoking is not permitted anywhere on the medical center campus and that intoxicating beverages or illegal drugs should not be consumed prior to reporting on duty. I further understand that violation of any of these restrictions will mean immediate dismissal.

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