Below are the printable forms you will need for volunteering. Please bring these completed forms with you, when you attend your interview: Volunteer Commitment and Confidentiality Agreement ✎ EditSign Volunteer Annual Health Form ✎ EditSign Background Consent for Adults ✎ EditSign Authorization for the Social Security Administration (SSA) To Release Social Security Number (SSN) Verification ✎ EditSign Volunteer Application Form Personal Information First Name First Name is Required Middle Initial Last Name Last Name is Required Birthdate Birthdate is Required Address Address is Required City City is Required State Select AK AL AR AZ CA CO CT DC DE FL GA GU HI IA ID IL IN IT KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VT WA WI WV WY State is Required Zip Code Zip Code is Required Cell Phone Cell Phone is Required Invalid Phone Number Email Email is Required Invalid Email Address Check appropriate blank(s) EmployedUnemployedStudentRetired Employer/School Employer Phone Emergency Information Emergency Contact Emergency Contact is Required Emergency Relationship Emergency Relationship is Required Emergency Contact's Phone Emergency Contact's Phone is Required Invalid Phone Number Doctor Information Preferred Doctor Doctor's Phone Invalid Phone Number Applicant Information Do you have any health or physical limitations that could affect your volunteer assignment? YesNo Please explain: Health Limitations Explanation is Required How did you first learn about our Volunteer Program? Visiting Whittier HospitalFriend/Family MemberInternet Site 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: Signature is Required Submit Application