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    Contact Information

    Emergency Contact Information

    Experience/Work History/Background
    Are you presently Employed? (Check all that apply)
    YesNoFull TimePart Time
    Past or current ORHC Employee?

    Do you have a record of founded child or dependent adult abuse or have you ever been convicted of a crime other than a simple misdemeanor offense relating to motor vehicles and laws of the road under chapter 321 or equivalent provisions, in this state or any other state?

    List two persons not related to you, who can judge your qualifications for this position. If you have previous experience as a volunteer, one reference should be from that organization. Please include COMPLETE addresses and phone numbers.

    Volunteer Service Area Preference (Check all that apply)
    Osceola Regional Health Center (Hospital Greeter): Welcomes patients and visitors upon their arrival to the hospital and help direct or escort them to their destination.Heartwood Heights: Assist with activities, provide one on one visitation to residents and assist staff on various outings.New Beginnings Thrift Store: Sort donated items, price and display merchandise.

    Availability (Check all that apply)

    Hours Preferred (Check all that apply)

    I understand and will comply with all of the following if accepted as a volunteer:
    ■ I voluntarily offer my services with a clear understanding that there is no monetary compensation
    ■ I will endeavor to be prompt and regular in my service.
    ■ I will observe all hospital regulations.
    ■ I authorize persons listed as references to release information.
    ■ I understand that Osceola Regional Health Center may complete a criminal background check.
    ■ I certify that all information on this application is true and complete.

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    Health Fact

    High blood pressure greatly increases your risk of heart disease and stroke. If your blood pressure is below 120/80 mm Hg, be sure to get it checked at least once every two years, starting at age 20. If your blood pressure is higher, your doctor may want to check it more often.