Volunteer Opportunities at Penn Medicine at Radnor: Application

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Volunteer Opportunities at Penn Medicine at Radnor

Overview

Benefits and Requirements

Application

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Apply Online

This online application may be used to apply for the Volunteer Program at Penn Medicine at Radnor. Before completing this application, please be sure to read about the benefits and requirements of the volunteer program.

This application is not secure in that it does not use 128-bit encryption to transfer information from your computer to our system. The information that you provide will be kept confidential and used only for the purpose of Volunteer Services at Penn Medicine at Radnor.

If you would prefer not to apply online, you may complete our paper application and mail it to us. (You will need FREE Adobe Acrobat Reader to view and print the paper application.)

Volunteer Application

Please note that your application is not complete until you press the "Submit" button at the end of the form.

PERSONAL INFORMATION

Title:	Mr. Miss Ms. Mrs.
First :
Middle:
Last:

Local Address
Street Address:
Apartment Number:
City, State, Zip:
Permanent Address
Street Address:
Apartment Number:
City, State, Zip:
Phone/Email
Local Phone Number:
Second Phone Number:
Cell Phone Number:
E-mail Address:
In an emergency, please call
Contact Name:
Relationship to you:
Phone Number:

Describe your interest in a volunteer position at Penn Medicine at Radnor:

Are you currently seeking volunteer service to fulfill a community service obligation (school, church, court referred)?

Yes No
If yes, please describe the service requirements:
Community Service Organization Contact:
Phone Number:

Is there anything that may adversely affect your ability to perform volunteer work, or that would require an accommodation in order for you to safely and competently perform volunteer work as requested?

Yes No

If yes, please describe, including details and accommodation requirements. The information you provide will be kept confidential.

EDUCATION

Please indicate the highest level of education completed.

High School:	9 10 11 12
High School Name:
High School Address:
College:	1 2 3 4
Graduate School:	1 2 3 4
College Name:
Degree or Major:

EMPLOYMENT EXPERIENCE

If you are under 18, do you have working papers?
Yes No

Please complete the following based on employment held within the last 10 years.

Have you ever worked for Penn Medicine at Radnor or any entity of the University of Pennsylvania Health System?
No Yes Currently employed by UPHS
If yes, work location:
Dates of employment:
Reason for leaving:

Current or past employer
Business Name:
Business Address:
Business Phone Number:
Position Title:
Supervisor's Name:

Current or past employer
Business Name:
Business Address:
Business Phone Number:
Position Title:
Supervisor's Name:

Current or past employer
Business Name:
Business Address:
Business Phone Number:
Position Title:
Supervisor's Name:

Current or past employer
Business Name:
Business Address:
Business Phone Number:
Position Title:
Supervisor's Name:

REFERENCES

Please provide complete information on two references. Current or former job supervisors, teachers, or clergy persons may serve as references. Family members, relatives and friends may not provide recommendations on your behalf.

Reference #1
Name:
Relationship to you:
Name of business or school:
Address:
Telephone number:
Reference #2
Name:
Relationship to you:
Name of business or school:
Address:
Telephone number:

REQUIRED: Have you ever been convicted of a felony?
Yes No

REQUIRED: Have you ever been convicted of a misdemeanor?
Yes No

If you answered Yes to either of these two questions regarding convictions, please describe the conviction(s) in detail, including dates:

REQUIRED: I certify that the information I have provided on this application is true and complete to the best of my knowledge. I understand that misrepresentation, falsification, or omission of information may disqualify me from further consideration for volunteering, or may result in my termination as a volunteer at Penn Medicine at Radnor. If accepted as a volunteer, I understand that I must abide by all of the policies, rules and regulations of Penn Medicine at Radnor. I authorize the Penn Medicine at Radnor Volunteer Services Department to investigate all statements contained in this application and to make inquiries of my personal references and medical history, as well as other related matters as may be necessary for determining my eligibility as a volunteer. I hereby release employers, schools or individuals from all liability in responding to inquiries relating to my volunteer application.

If you are satisfied with your application, please press the "Submit" button below. Your application is not complete until you press "Submit".

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