Volunteer Services Application

Please choose the option that best describes you. Adult VolunteerCollege StudentHigh School Student

Please tell us about your employment and volunteer experience.

Have you ever been employed by Conemaugh Health System? YesNo

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:

Have you ever been convicted of any violation other than a misdemeanor or summary offense? YesNo

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 CenterConemaugh Meyersdale Medical CenterConemaugh Miners Medical CenterConemaugh Nason Medical CenterConemaugh Regional Hospice

Month Availability: June - August (Summer)September - May (Student school year)

Morning Availability: SundayMondayTuesdayWednesdayThursdayFridaySaturdaySunday

Afternoon AvailabilitySundayMondayTuesdayWednesdayThursdayFridaySaturdaySunday

Evening AvailabilitySundayMondayTuesdayWednesdayThursdayFridaySaturdaySunday

Volunteer Application