Bayfront Medical Center: Volunteers

Online Volunteer Form

Please enter the following data and hit the Submit button below to indicate your interest in becoming a Bayfront volunteer.

Volunteer Application

Personal Data:

First Name:
Middle Initial:
Last Name:
Address:
City:
State:
Postal Code:

Phone:
Social Security #:
Birth Month/Day:
How long at current address?:
Previous address?:

Are you a United States Citizen?:	Yes No
If you are not a United States Citizen, do you have a Visa and what country is it from?:
Have you ever been convicted of, pled guilty or pled nolo contendere to a felony and/or misdemeanor?:	Yes No
If yes, explain (your response will not necessarily disqualify you):

Emergency Contact:
Name:
Address:
Phone:
Relationship:

Job Objective:
Volunteer job interested in:
How did you hear about the job:
Hours preferred:
Days available to work:
Can you perform all aspects of the job? If not, is there something that could accommodate your doing the job?:
Months away from St. Petersburg:
Skills/Interests you have to contribute:

Personal References: - professional associates or friends, not relatives or former employers

Name	Address	Phone	Occupation

Education:

	Name of school & address	Years completed	Diploma/Degree

High School
College

Employment History:

Name of Company/Business:
From Mo./Yr	To Mo./Yr
Address:	City:
State:	Telephone:
Job Duties:
Reason for leaving:

May we contact your employer?	Yes	No

PLEASE READ CAREFULLY BEFORE SIGNING I certify that the information contained in this application is correct to the best of my knowledge and I understand that falsification of this information whenever discovered is grounds for refusal to place, or if placed, dismissal. I authorize any of the persons or organizations referenced in this application to give you any and all information concerning my previous employment, education, or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application and release all such parties from all liability for any damage that may result from furnishing such information to you. I authorize you to request and receive such information. I further authorize that Bayfront Health System can perform any background checks, including criminal, deemed necessary for considerment of placement.
In consideration of becoming a volunteer, I agree to conform to the rules and regulations of the Hospital.

Signed

Required.

Date

Required.

Verfication Key:

Volunteer Application

Apply today to make a difference as a Bayfront Volunteer.

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