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Volunteer Application

Our application is secure and we will not share your personal information with any other parties, with the exception of the background check to be completed after interview and orientation.

Please fill out the application form below to become a Barnes-Jewish Hospital Volunteer. If you prefer to print and mail your application, please download the PDF version of the form, and return your completed application to:
Barnes-Jewish Hospital
Volunteer Services
Mail stop 90-72-404
One Barnes-Jewish Hospital Plaza
St. Louis, MO  63110

Please do not complete this form if you are interested in the Teen Summer Volunteer Program. Teens interested in volunteering should call 314-362-5324 for more information and the appropriate application.

  
If under the age of 18, please indicate a name and phone number where your parent/guardian can be reached to verify your application.

Applicant

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First Name
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Last Name
*
Address
Address 2
*
City
*
State
*
ZIP
*
Phone
Alternate Phone
*
Email Address

Emergency Contact Information

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Name of Emergency Contact
*
Relationship to Applicant
*
Phone Number

Employment

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Past or Present Employer
*
Address
Address 2
*
City
*
State
*
ZIP
*
Phone Number
*
Position Held
*
Dates of Employment

MM/YY - MM/YY or present

Education

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High School
*
High School Graduate
*
Graduated from College
University/College
Major
Degree
*
Are you currently enrolled in higher education of any kind?

(College, post baccalaureate, graduate school, etc.)

References

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Reference 1: Name

Please provide the first and last name of a reference that is current and professional in nature (may not use relatives.)

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Address
Address 2
*
City
*
State
*
ZIP
*
Phone
*
Reference 2: Name

Please provide the first and last name of a reference that is current and professional in nature (may not use relatives.)

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Address
Address 2
*
City
*
State
*
ZIP
*
Phone Number
*
Have you ever been employed by Barnes-Jewish Hospital?
If yes, please specify dates of employment.

MM/YY - MM/YY or present

*
Have you ever been convicted of, or entered a plea of guilty to a felony, misdemeanor criminal charge or local non-ordinance including one in which you received a suspended imposition of sentence, suspended execution of sentence or any period of probation or parole?
If yes, specify the offense and the date, place and court.
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By selecting "Agree," I hereby affirm that the information provided on this application is true and complete to the best of my knowledge. Falsification of information may disqualify me from volunteer service and may justify my dismissal at a later date. I release from all liability or responsibility all persons or organizations requesting or supplying information regarding my character and qualifications I also understand that my photograph might be taken and used in hospital publications/marketing materials.

Volunteer Assignment

Please indicate your preferred volunteer commitment:



Please indicate your preferred start date or date range.

MM/DD/YY or MM/DD/YY - MM/DD/YY

Special Programs:
Must be secured prior to filling out this application.


If you are interested in other special programs, please specify.
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Why are you interested in volunteering at Barnes-Jewish Hospital?
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Which day(s) of the week are best for you to volunteer?






*
How many hours per week are you available to volunteer?
*
What time of day is best for you to volunteer?
Security Code
Type Security Code

Find a doctor or make an appointment:
General Information: (314) 747-3000
One Barnes-Jewish Hospital Plaza
St. Louis, MO 63110
© Copyright 1997-2014, Barnes-Jewish Hospital. All Rights Reserved.