Penn Presbyterian Medical Center

Discover how you can enrich your life. Apply for the Adult Program (18+) at Penn Presbyterian Medical Center.

The information that you provide will be kept confidential and used only for the purpose of Volunteer Services at Penn Presbyterian Medical Center.

Applicant Information
Title



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Date of Birth
Local Address
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Permanent Address
Contact Information
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Emergency Contact Information

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

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Additional Information
Are you currently seeking volunteer service to fulfill a community service obligation (school, church, court referred)?

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?

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Education

Please indicate the highest level of education completed.

High School



College



Graduate School



Employment Experience - Penn Medicine

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 Penn Medicine?


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Employment Experience: Employer 1
Status

Employment Experience: Employer 2
Status

Employment Experience: Employer 3
Status

Employment Experience: Employer 4
Status

Volunteer Experience
Type of volunteer service preferred

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







Reference #1

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 #2

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.

Criminal Background Check
Have you ever been convicted of a felony?

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Have you ever been convicted of a misdemeanor?

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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 PPMC. 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.*
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