The Auxiliary is a service organization committed to encouraging volunteerism at the hospital and promoting community involvement in fundraising efforts for special hospital purchases.

This is a

Full Name

Spouse

Address

City, State & Zip Code

Phone

Email Address

Are you at least 15 years old?

Please provide me with more information on:

Computer Skills, Special Skills & Interests

Current/Previous Occupations

Volunteer Experience

Service Area Preferred

Please let us know your preference(s) of days volunteering.

Service Auxilians only will supply 3 references and submit to a Criminal Background check.

Please list three (3) references that are not relatives: (Name, Phone, Relationship)

Fund Raising Auxilians (those Auxilians involved in fundraising efforts)

Interested in

Ambassadors (those Auxilians who offer community support as needed)

Interested in

I hereby affirm that the information provided on this application is true and complete to the best of my knowledge.

I hereby consent and authorize Morris Hospital to administer any lawful testing, which may be necessary to fulfill the minimum health requirements as a service volunteer.

I understand that my volunteering is at-will which means that I may terminate at any time and for any reason and that the facility has the same right. I have read and fully understand the above information.

Name (Acts as signature)

Date

**All Service Auxilians, please call the Volunteer Coordinator at (815)942-2932, x7022 to set up an interview .

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