Welcome to St. Joseph Mercy Ann Arbor's Volunteer Website!

Volunteer Application

Please Select the Location You Are Interested in
Which volunteer program are you applying for?
Application date
Personal Information
First Name
Last Name
Address
City
State
Cell Phone
Zip/postal
E-mail
DOB
Gender
Emergency Contact
Phone
Relationship
Employment
From
To
Name of Company
Mo/Yr.
Mo/Yr.
Position and Duties
City, State
Name of Company
Mo/Yr.
Mo/Yr.
Position and Duties
City, State
Volunteer Position
Name of Organization
Mo/Yr.
Mo/Yr.
Position and Duties
City, State
Name of Organization
Mo/Yr.
Mo/Yr.
Position and Duties
City, State
Have you ever volunteered, been an employee or student intern/job shadow with the health system?
Yes
No
If yes, please indicate:
Department
Position
Education Status
High School
Current Grade or Grade Completed
College/University
Current Level or Highest Level Completed
Field of Study
Are you currently a student?
Yes
No
Minimum time committment is one 4 hour block of time on a set schedule, same day evey week. Please check boxes below to indicate the days and time you are available to volunteer.
Times/Days
Morning
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Afternoon
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Evening
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Skills/Interests
Skills I have (ckeck all that apply)
Clerical
Data/Computer
Cooking Classes
Entertainment
Patient Care
Reception
Escorting
Experience Advisor
What other services are you interested in providing?
Have you ever been convicted of anything other than a minor traffic citation, or are there felony charges pending against you?
Yes
No
If yes, please list dates, places, charges and dispostion of all convictions:
Select the location(s) you are interested in volunteering at:
Ann Arbor
Brighton
Canton
Livingston
Believing that Saint Joseph Mercy Health System (SJMHS) has a need for my services as a volunteer, I agree:
1. I voluntary offer my services with a clear understanding there will be no momentary compensations and that volunteering does not lead to employment.
2. To hold as absolutely confidential all information that I may obtain directly or indirectly concerning patients, families, physicians, or personal. I agree that I will not seek confidential information in regard to a patient or SJMHS personal.
3. That I will commit to the minimum requirements for months of volunteer service for the program I am participating in. I will adhere to the agreed upon schedule which would involve notifying areas in case of absences.
4. That if I accept a volunteer position, I will have a duty to be familiar with SJMHS' rules, standards, and policies as they now exist or as they may be modified, added to, or abolished in the future. I have reviewed and agree to comply with these rules, standards, and policies.
5. To wear the designated volunteer uniform and ID at all times while volunteering for SJMHS and to return the uniform and ID badge when I am no longer an SJMHS volunteer.
6. To give a minimum of two weeks notice to the volunteer department when I will be terminating my volunteer service.
I certify that the answers given by me to the foregoing questions are true and without omissions. Misrepresentation of facts constitutes separation from Volunteer Services. I agree to abide by all Saint Joseph Mercy Health System rules and regulations. It is further understood that the Volunteer Services Department is not obligated to provide a placement, nor am I obligated to accept the position offered.
Applicant Signature:
Date:
Date:
Parent/Guardian Signature:
(Minors under 18)