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Volunteer Application

Volunteer Application

Please fill in all of the information below - be aware that all fields are required for the form to go through.

Once you have submitted our applications, please follow up with a call (585) 396-6660 the next day to confirm that you application was received and to schedule an appointment for an interview.

You may also stop in and pick up an application in the hospital lobby.

To Become a Volunteer:

Once you have submitted your application, please follow up with a call the next day to ensure that your application was received. You may also stop in and pickup an application at the hospital lobby information desk.
    1. Submit an application and call us to schedule an appointment for an interview
    2. Call 396-6660, Monday - Friday
    3. Make a commitment at least 3 - 4 hours each week (winter/summer volunteers also needed)
    4. Attend the Hospital Orientation Program
    5. Complete the health assessment steps
Last Name *
First Name (Legal) *
Address
City
State
Zip
Email *
Phone *
Do you have a legal right to remain and work in the United States?
Have you ever been convicted of a crime?
If yes, please explain
High School Name
High School Degree
Have you ever been employed here before?
Please list your employment or volunteer work during the last 10 years.
Date FromDate ToName of EmployerPosition Held
Select Date Select Date
Select Date Select Date
Select Date Select Date
Select Date Select Date
When are you available? Days/Hours available? (Check any that apply):
 DayTimes Available
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Please check any task in which you have
an interest and/or experience












Are you currently a member of the Thompson Guild?
Please list former supervisors, associates, and/or acquaintances with whom you are familiar and who could be contacted as a reference for you. Do not list relatives.
Name
How Long Known
Phone
Name
How Long Known
Phone
The information provided in this application to volunteer is true, correct and complete. I understand that, if I volunteer, any information found to be false might subject me to dismissal. I authorize the use of any information in this application to verify my statements, and I authorize personal references to answer all questions concerning my ability to perform the volunteer task for which I am applying. If I become a volunteer, I agree to abide by all present and subsequently-issued Health System policies. This agreement does not bind with party for any specific period of time.
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