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Date: - Volunteer Assessment Survey: First Name

This document is a volunteer assessment survey for a hospital volunteer services department. It requests information such as name, address, phone number, email, availability, interests in different hospital departments, skills, qualifications, and previous volunteer experience. Volunteers are placed in regular weekly assignments that may be available from early morning to late evening, 7 days a week, with some evening and weekend opportunities. Departments listed for potential placement include admitting, surgery, patient transport, clerical work, and others.

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Gilbert Cook
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95 views

Date: - Volunteer Assessment Survey: First Name

This document is a volunteer assessment survey for a hospital volunteer services department. It requests information such as name, address, phone number, email, availability, interests in different hospital departments, skills, qualifications, and previous volunteer experience. Volunteers are placed in regular weekly assignments that may be available from early morning to late evening, 7 days a week, with some evening and weekend opportunities. Departments listed for potential placement include admitting, surgery, patient transport, clerical work, and others.

Uploaded by

Gilbert Cook
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Volunteer Services, A1-26

79-01 Broadway
Elmhurst, NY 11373
718-3345175
[email protected]

Date: _____ Volunteer Assessment Survey


First Name:

Last Name:

Home Address:

Home Phone:

Cell Phone:

Email Address:

Date of Birth

Referred By:

Availability:
Volunteers are placed in a regular weekly assignment. Some assignments are available seven days a week,
early morning through late evening. There are limited evening and weekend assignments. Please check your
availability below. This information will help us determine the possible position openings that may be of
interest to you.

Shift Monday Tuesday Wednesday Thursday Friday Saturday Sunday

8 AM – 12 PM

1 PM – 5 PM

5 PM – 8 PM
The following are a few departments where volunteers can work:
 Admitting Department
 Ambulatory Surgery
 Ambassador Program (Meet, greet and assist patients and families)
 Cancer Patient Support
 Clerical
 Emergency Department
 Inpatient (Visiting patients and providing non-clinical support)
 Outpatient (Lobby rounds, clerical support, stock supplies)
 Patient Advocacy
 Patient Transport
 Pharmacy Department
 Physical & Occupational Therapy
 Radiology Transport
 Special Programs (Healthy Outlook & After School Programs)
 Spiritual Care Department

From the list above, please list your top three in order of highest interest to you:

1) _________________________________________

2) _________________________________________

3) _________________________________________

Special skills and qualifications you have acquired from employment, previous volunteer work, or
through other activities, including hobbies or sports:

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

Previous volunteer experience:


_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

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