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Volunteer Application

The Kennedy Health System needs volunteers of all ages and backgrounds to assist our three hospitals in their day-to-day functions.  To apply for one of our volunteer positions, please complete the following application. 

All applications will be reviewed by our Volunteer Services department and prospective volunteers will contacted to arrange for an in-person interview.


Contact Information
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  • First Name:

  • Last Name:

  • Company:

  • Address:

  • City:

  • State:

  • Zip:

  • Contact Number:

  • Email:

Work Experience and Availability

  • Are you currently employed?

  • If employed, please select your employment type:

  • Are you currently seeking paid employment?
  • Occupation:
  • Current Employer (name and address):
  • Will you be available for at least 12 months from today?
  • Will you be able to volunteer a minimum of one 3 hour shift?
  • Please select the days and hours you will be available to volunteer:

Volunteer Application Infomation

  • Volunteer Type:

  • Select an assignment preference:

  • Please Select a Hospital:

  • Please supply two references. (Please do not include relatives)

  • Reference name, complete mailing address and contact number (incomplete addresses will be not accepted):

  • Reference name, complete mailing address and contact number (incomplete addresses will be not accepted):

  • Physician Reference for Medical Clearance (Name, Address, City, State, Zip & Phone Number)
  • Emergency Contact Information
  • Name:
  • Relationship:
  • Contact Number:
Junior Volunteer Information
  • High School Applicants Only
  • Name of Parent or Legal Guardian:
  • Are you receiving school or service credit for volunteering?
  • If you are receiving service or school credit, how many hours do you need?
  • School Information (name, full address, phone number):
  • Name of Guidance Counselor:
  • Graduation Year:
  • College Student Applicants Only
  • College Information (name, full address, phone number):
  • Major:
  • Year of Graduation:
  • Please list any extracurricular activities:
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  • Are you receiving school credit for volunteering?
  • If you are receiving credit, how many hours do you need?
Volunteer Questionaire

  • Have you worked or volunteered in a healthcare setting before?  If so, please explain.

    1000 Characters left

  • Do you have any conditions that you wish to have considered during the placement process? If yes, please explain.

    1000 Characters left

  • Have you ever been convicted of a felony?  If yes, please explain below.

  • Please give details of any convictions or offenses.  Include date, location, sentencing court and nature of the sentence.  Please note that convictions do not automatically disqualify applicants from volunteering.
    2000 Characters left
  • Have you knowingly used non-physician prescribed narcotics, amphetamines, or barbiturates within the last 3 years? If yes, please explain below.
  • Please explain any drug use.
    2000 Characters left
Kennedy E-Newsletter Sign-up

  • Would you like to subscribe to Kennedy's e-newsletter?

Application Agreement and Acknowledgement
  • By submitting this form I agree to allow the Kennedy Health System to investigate any and all information concerning my volunteer application in order to determine my qualifications.  This includes, but is not limited to, medical clearance, criminal background checks, employment and personal reference checks, and educational or certification verification.  I understand that any misrepresentation of facts contained in this application may be cause for my rejection or dismissal.

    I also agree to be photographed by the hospital for a hospital issued identification badge.

    I agree that my personal property, including packages, briefcase, purse or any other hand luggage may be inspected by authorized personnel.

    I agree to abide by all hospital rules, regulations and policies.  I understand that if placed, my placement will be subject to the conditions of any applicable introductory period established by hospital policy. I understand that this application and any other hospital documents do not constitute an employment contract, and that any volunteer may voluntarily leave with proper notice, and may be dismissed by the hospital at any time and for any reason.

    I understand that in the event of my resignation or dismissal by the hospital, I must return all hospital property, such as identification badges, uniforms, keys, etc.
  • I agree with the above terms of applying to volunteer at Kennedy Health System.