High School Volunteer Application

Please allow yourself approximately 15 minutes to accurately and thoroughly complete this volunteer application.
If you have trouble or need assistance, please contact Volunteer Services at 989.583.6040.
Thank you for your interest in volunteering at Covenant HealthCare!

New User Details

User ID

User ID (verify)

Password

Password (verify)

Applicant Information

* First name

* Family/last name

Preferred First Name

Date of Birth (High school students need to be 16 or older by September 1 of the current year.)

* Home address

* City

* State

* Zip Code

* Primary phone

Mobile phone

* E-mail address

Gender

Race/Ethnicity (Optional)

Parent and Emergency Contact Information

Please list parent or guardian contact information in case of emergency. Please make sure this is someone we can contact with information about your volunteering at Covenant HealthCare.

* Contact name

* Primary phone (Mobile Preferred)

E-mail address

* Relationship

References

Please provide name and phone number for two references. Do not list relatives.

* Name

* E-mail

Phone

Relationship

* Name

* E-mail

Phone

Relationship

Employment History

Employer Name

Employer Address

Dates of Employement

Job Title

Type of Work

Volunteer Experience

Other volunteer services you have participated in. Please include type of duties performed.

Education

* High School

* Grade Point Average (Taken from last report card, will be verified)

* Year Graduating

Skills

Please share with us why you would like to volunteer at Covenant HealthCare and what skills you would bring to our organization.

Additional Information

Please list any health conditions which may prevent you from performing any of the volunteer responsibilities.

Additional information or comments you would like to share with us prior to submitting your application?

Have you ever been convicted of a crime, including a misdemeanor?

Are there any legal charges pending against you?

If yes (legal charges pending) please explain:

Are you volunteering to satisfy a court ordered probation?

If yes, please list probation officer's name and phone.

Authorization and Signature

* I understand that 40 hours of volunteer service need to be completed prior to a letter of recommendation is completed or a release of hours can be provided to the school.

* I certify that the responses on this application are true to the best of my knowledge. I agree that this information may be verified and my references may be contacted by Covenant HealthCare Volunteer Services. I authorize Covenant HealthCare to perform all necessary background checks and understand my date of birth is necessary for these checks. If accepted for volunteer placement, I will comply with the values, policies and procedures of Covenant HealthCare in effect or revisions which may be issued in the future.  Misrepresentation of facts constitutes cause for separation from volunteer placement. I understand that the position that I am applying for is an unpaid volunteer position.

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E-Signature