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Volunteer Application for Conemaugh Health System
 
 
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Thank you for your interest in volunteering at Conemaugh Health System!

Please complete the following Volunteer Application.  When you are finished, click the "Apply to Volunteer" button at the bottom of the page.

Disclaimer: This is not a secure website. All information is given voluntarily thereby giving consent to be used through the Volunteer Services office.
If you wish to receive a paper copy of this application, contact Rose Selfridge, Volunteer Services at rselfri@conemaugh.org or by calling (814) 534-9129.

Do not include apostrophes (') in this form. You will receive an error message.
If your email address contains an apostrophe ('), please contact Rose at the email address above to submit your information.

 

Name:
Address:
Phone:
Email Address:
Date of Birth:
Last Four (4) Digits of Social Security Number:
   
High School or College:
Graduation Year:
   
Are you interested in a Health Care Career?
If yes, in what area of interest?
   
Please tell us about your Employment and Volunteer experience:
Have you ever been employed by Conemaugh Health System?
   
How did you become interested in our program?
   
Please list two references that are not family members or employers.  Please include their telephone numbers.
First Reference:
Second Reference:
   
Have you ever been convicted of any violation other than a misdemeanor or summary offense?
If yes, please describe in full:
   
Please describe your assignment preference:

I would prefer:
  

at the following location(s):

in the following setting:
   

Please list your potential availability:
Mornings:
Afternoons:
Evenings:
A criminal background check will be performed for all applicants age 18 or older