Volunteer Application

Wheaton Franciscan Healthcare will consider all qualified individuals interested in contributing volunteer service without regard to race, religion, disability, color, age, sex or national origin.

All fields marked with * are required.

Who are you?

Contact Information
Emergency Contact
Volunteer Commitment
Mo Yrs

Work, Volunteer, or Community Experience
References (Not Relatives)
Volunteer Agreement

I understand that if accepted as a volunteer:

• I agree that at no time will any information regarding patients or operations of the hospital be revealed to anyone other than those authorized to receive it.

• I agree to supply any pertinent health history that may affect my volunteer position.

• I authorize permission for all named references and educational institutions to release personal and professional information to the Volunteer Services office. I also consent to a check of my driving record and police search if required. I further release Wheaton

Franciscan Healthcare, as well as those supplying information, from any and all liability from these investigations. I understand that information collected during this background check will be limited to that appropriate to determining my suitability for particular types of volunteer work and that all such information collected during the check will be kept confidential.

• I voluntarily offer my services with a clear understanding that there is no monetary compensation.

• I will observe all rules and regulations specified by Wheaton Franciscan Healthcare.

• I understand that any false statement made as part of this application may be considered sufficient cause for termination of my volunteer agreement.

• I agree to adhere to the code of conduct guidelines as set forth by the Volunteer Services Department, located in the Volunteer Handbook.