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Volunteer Services Application
Volunteer Application
First and Last Name
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Phone Number
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Date of Birth
Last 4 Digits of SSN
Please choose the option that best describes you.
Adult Volunteer
College Student
High School Student
Please tell us about your employment and volunteer experience.
Have you ever been employed by Conemaugh Health System?
Yes
No
How did you become interested in Conemaugh's volunteer program?
Please list two references that are NOT family members or employers. Please include telephone numbers for each reference. Reference #1:
Reference #2:
Have you ever been convicted of any violation other than a misdemeanor or summary offense?
Yes
No
If yes, please describe in full:
Please describe your volunteer assignment preference. I would prefer:
Please identify the entity or entities where you would like to volunteer:
Conemaugh Memorial Medical Center
Conemaugh Meyersdale Medical Center
Conemaugh Miners Medical Center
Conemaugh Nason Medical Center
Conemaugh Regional Hospice
Month Availability:
June - August (Summer)
September - May (Student school year)
Morning Availability:
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Friday
Saturday
Sunday
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