Hospital of the University of Pennsylvania

Adult Volunteer Online Application for the Hospital of the University of Pennsylvania

This online application is for the Adult Volunteer Program at the Hospital of the University of Pennsylvania. If you are interested in a different program, please choose: Nursing & Allied Health, Premed, or Teen.

Note: This application is not secure in that it does not use 128-bit encryption to transfer information from your computer to our system. The information that you provide will be kept confidential and used only for the purpose of Volunteer Services at the Hospital of the University of Pennsylvania.

TheThis field is required icon indicates the field is required.

 

Full Name

Title:  

Mr. Miss Ms. Mrs.

First:  

This field is required

Middle:  

Last:  

This field is required

spacer

Date of Birth:  


Enter (mm/dd/yyyy)

Ethnicity

Ethnicity:  

This field is required

Local Address

Street Address:  

This field is required

Apt. / P.O. Box / Suite:  

City / Town:  

This field is required

State:  

This field is required

Zip:  

This field is required

Permanent Address

Street Address:  

Apt. / P.O. Box / Suite:  

City / Town:  

State:  

Zip:  

Phone / Email

Daytime Phone Number:  

This field is required

Second Phone Number:  

Cell Phone:  

Email Address:  

This field is required

Re-type Email Address:  

This field is required

Emergency Contact Information

In the event of an emergency, who should we contact?

Contact Name:  

This field is required

Relationship to you:  

This field is required

Phone Number:  

Additional Information

Please indicate the days and times that you are available to volunteer.

  Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Morning:
Afternoon:
Evening:

Please provide a brief bio describing yourself, why you want to volunteer, and any skills or abilities you'd like to use as a volunteer. This field is required

Are you currently seeking volunteer service to fulfill a community service obligation (school, church, court referred)? This field is required

Yes No

If yes, please describe the service requirements:

Community Service Organization Contact:  

Phone Number:  

Is there anything that may adversely affect your ability to perform volunteer work, or that would require an accommodation in order for you to safely and competently perform volunteer work as requested? This field is required

Yes No

If yes, please describe, including details and accommodation requirements. The information you provide will be kept confidential.

Assignment Preference

We have many opportunities at HUP, however, not all assignments listed below may currently be available. Please select all opportunities that may interest you: (check all that apply)

Administrative/Clerical Support Musician or Musician Guide
Animal Assisted Therapy Pastoral Care
Caring Clown Patient Care Unit Support
Committee or Council Member REIKI
Greeter & Host No Preference
  Other

Education

Please indicate the highest level of education completed. Select only one:

Some high school
High School/GED
Some college
Bachelor's Degree
Master's Degree
Advanced Graduate work or Ph.D.

Employment Experience

Please complete the following based on employment held within the last 10 years.

Have you ever worked for HUP or any entity of the University of Pennsylvania Health System?This field is required

No Yes Currently employed by UPHS

If yes, work location:  

Dates of employment:  

Reason for leaving:  

 

Current    or past employer

Business Name:  

Business Address:  

Business Phone Number:  

Position Title:  

Supervisor's Name:  

 

Current    or past employer

Business Name:  

Business Address:  

Business Phone Number:  

Position Title:  

Supervisor's Name:  

 

Current    or past employer

Business Name:  

Business Address:  

Business Phone Number:  

Position Title:  

Supervisor's Name:  

 

Current    or past employer

Business Name:  

Business Address:  

Business Phone Number:  

Position Title:  

Supervisor's Name:  

References

Please provide complete information on two references. Current or former job supervisors, teachers, or clergy persons may serve as references. Family members, relatives and friends may not provide recommendations on your behalf.

Reference #1

Name:  

This field is required

Relationship to you:  

This field is required

Name of business or school:  

This field is required

Address:  

This field is required

Telephone number:  

This field is required

Reference #2

Name:  

This field is required

Relationship to you:  

This field is required

Name of business or school:  

This field is required

Address:  

This field is required

Telephone number:  

This field is required

Criminal Background Check

Have you ever been convicted of a felony? This field is required

Yes No

Have you ever been convicted of a misdemeanor? This field is required

Yes No

If you answered Yes to either of these two questions regarding convictions,
please describe the conviction(s) in detail, including dates:

Application Certification

I certify that the information I have provided on this application is true and complete to the best of my knowledge. I understand that misrepresentation, falsification, or omission of information may disqualify me from further consideration for volunteering, or may result in my termination as a volunteer at the Hospital of the University of Pennsylvania. If acceptedas a volunteer, I understand that I must abide by all of the policies, rules and regulations of the Hospital.

I authorize the Hospital of the University of Pennsylvania Volunteer Services Department to investigate all statements contained in this application and to make inquiries of my personal references and medical history, as well as other related matters as may be necessary for determining my eligibility as a volunteer. I hereby release employers, schools or individuals from all liability in responding to inquiries relating to my volunteer application.

Click here to certify the application: This field is required

Submit

If you are satisfied with your application, please press the "Submit" button below.
Your application is not complete until you press "Submit."

To Top