About Us

About Us

Welcome to AHMC Whittier Hospital Medical Center

Volunteer Application Form
Personal Information
First Name
Middle Initial
Last Name
Birthdate
Address
City
State
Zip Code
Cell Phone
Email
Check appropriate blank(s)
Employer/School
Employer Phone
Emergency Information
Emergency Contact
Emergency Relationship
Emergency Contact's Phone
Doctor Information
Preferred Doctor
Doctor's Phone
Applicant Information
Do you have any health or physical limitations that could affect your volunteer assignment?
Please explain:
How did you first learn about our Volunteer Program?
What do you hope to get out of your volunteer experience?
Education: background, hobbies, or special interests
What is your experience in dealing and working with the public?
Certification and Authorization (Please read thoroughly) I certify that the information provided in the Volunteer Application is true, correct and complete. I authorize verification of all statements contained in this Application. I authorize former employers and/or educational institutions to provide information concerning me, and I release them from liability for providing any such information to Whittier Hospital Medical Center. (Please type out your name below)
Signature: