• Departments & Services
• For Patients
• Research & Trials
• Education
• Find a Doctor

Penn Presbyterian Medical Center

Volunteer Opportunities at Penn Presbyterian Medical Center

• Home
• About Us
• Visitor Information
• Services & Specialties
• Volunteer Opportunities

• Make an appointment
• Find a doctor

• Overview
• Adult Program
• College Program
• Apply Online

Apply Online

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 Penn Presbyterian Medical Center.

If you are not ready to apply online yet, click here to return to the overview page for Penn Presbyterian volunteers.

The icon indicates the field is required.

Choose a Program

	Adult Volunteer Program
	College Volunteer Program

Full Name

Title:	Mr. Miss Ms. Mrs.
First:
Middle:
Last:
Date of Birth:	MM/DD/YYYY

Local Address

Street Address:
Apt. / P.O. Box / Suite:
City / Town:
State:
Zip:

Permanent Address

Street Address:
Apt. / P.O. Box / Suite:
City / Town:
State:
Zip:

Phone / Email

Daytime Phone Number:
Second Phone Number:
Cell Phone:
Email Address:
Re-type Email Address:

Emergency Contact Information

Contact Name:
Relationship to you:
Phone Number:

Additional Information

Describe your interest in a volunteer position at Penn Presbyterian:
Are you currently seeking volunteer service to fulfill a community service obligation (school, church, court referred)?	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?	Yes No
If yes, please describe, including details and accommodation requirements. The information you provide will be kept confidential.

Education

Please indicate the highest level of education completed.
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:

Employment Experience

Please complete the following based on employment held within the last 10 years.
Have you ever worked for Penn Presbyterian Medical Center or any entity of the University of Pennsylvania Health System?	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:
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:

Criminal Background Check

Have you ever been convicted of a felony?	Yes No
Have you ever been convicted of a misdemeanor?	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

Click here to certify the application:

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 Penn Presbyterian Medical Center. If accepted as a volunteer, I understand that I must abide by all of the policies, rules and regulations of the hospital. I authorize Penn Presbyterian Medical Center 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.

Submit

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