Volunteer opportunities at Pennsylvania Hospital

Adult Opportunities

Please use this online application only if you are over 18 years of age.

Printable Application

If you would prefer not to apply online, you may complete our printable application (.pdf) and mail it to us at:
800 Spruce Street
Philadelphia, PA 19107

(You will need FREE Adobe Acrobat Reader to view and print the paper application.)

If you are 14 to 17 years of age, please contact the Volunteer Services office at 215-829-5187 for an application and more information. Please see our Junior Volunteer section for further information and requirements for our various programs.

Pennsylvania Hospital is located at 800 Spruce Street in Philadelphia. The Hospital of the University of Pennsylvania, located at 3400 Spruce Street, has a separate volunteer program.

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 Pennsylvania Hospital.

Volunteer Application for the Adult Program

Please note that your application is not complete until you press the "Submit" button at the end of the form.

PERSONAL INFORMATION

*Note: Teen volunteers may not apply online.

Title:

Mr.   Miss   Ms.   Mrs.  

First :

Middle:

Last:

Date of Birth:

(mm/dd/yyyy)

Address

  

Street Address:

Apartment Number:

City, State, Zip:

Phone/Email

  

Home Phone Number:

Work Phone Number:

E-mail Address:

In an emergency, please call

Contact Name:

Relationship to you:

Phone Number:

Date of Birth:

(mm/dd/yyyy)

EMPLOYMENT AND VOLUNTEER EXPERIENCE

Are you currently employed?

Yes    No

 

Most Recent Employment

Business Name:

Business Address:

Position Title:

Supervisor's Name:

Description of Duties:

Reason for leaving:

   

Previous Employment

Business Name:

Business Address:

Position Title:

Supervisor's Name:

Description of Duties:

Reason for leaving:

EDUCATION

High School:

9 10 11 12

High School Name:

High School Address:

College:

1 2 3 4

Graduate School:

1 2 3 4

College Name:

Degree or Major:

 

I have been a volunteer for: (fill in agency)

Agency Name:

Positions Held:

Dates:

 

Do you have any special skills or interest you would like to use as a volunteer?

 

Type of volunteer service preferred:

Working with or near patients
I would prefer little or no patient contact at this time

 

Days preferred:

Monday

 

Tuesday

 

Wednesday

 

Thursday

 

Friday

Hours preferred:

REFERENCES

No relatives or personal physicians please. References can be from employers, professors, personal friends, previous Volunteer Services Directors, etc). Prefer at least one professional reference, if possible.

Reference #1

  

Name:

Relationship to you:

Name of business or school:

Address:

Telephone number:

Reference #2

  

Name:

Relationship to you:

Name of business or school:

Address:

Telephone number:

REQUIRED: I am applying for a volunteer experience at Pennsylvania Hospital. I have carefully read the application statement and have provided accurate information to the best of my knowledge. The facts set forth in my application are true and complete. Permission is given to the University of Pennsylvania Health System (UPHS) to verify all information I have provided in this application. Unless otherwise indicated in the application I authorize all persons or entities to provide any relevant information to UPHS or its agents for use in its investigation and release them from any liability for doing so. I understand and agree that any misrepresentation or omission of facts in my application will be justification for refusal or termination of volunteer service. I understand and agree that this volunteer application and other UPHS documents or statements are not contracts of employment or volunteer service. Volunteer placement is contingent upon successful completion of a post offer physical, and background investigation, including a criminal history record check.

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

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